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Review
. 2025 Mar-Apr;35(2):187-197.
doi: 10.25259/IJN_222_2024. Epub 2024 Nov 28.

Nutrition Compass: Guiding Patients with Chronic Kidney Disease Across Ages

Sukanya Govindan  1 , Arpana Iyengar  2 , Subashri Mohanasundaram  3 , P S Priyamvada  4
Affiliations
Review

Nutrition Compass: Guiding Patients with Chronic Kidney Disease Across Ages

Sukanya Govindan et al. Indian J Nephrol. 2025 Mar-Apr.

Abstract

Malnutrition, encompassing both undernutrition and overnutrition, is prevalent among patients with chronic kidney disease (CKD). It is influenced by a myriad of factors, including dietary restrictions, metabolic irregularities, inflammation, and comorbidities. It leads to increased morbidity, mortality, and diminished quality of life. In children, malnutrition hinders growth and development, particularly during infancy and early childhood. This article provides a comprehensive overview of current terminologies delineating undernutrition and overnutrition in CKD, and discusses age-specific nutritional assessment tools. It delves into macro- and micronutrient prescriptions tailored for both adults and children with CKD, emphasizing special considerations such as low and very low protein diets. A focus on the nutrient content of Indian foods is also provided, alongside available nutritional supplements, with insights into enteral feeding and the fortification of feeds in young children. Distinctive nuances in nutritional therapy between adults and children are elucidated throughout the article, drawing upon established guidelines, including Kidney Disease Outcomes and Quality Initiative (KDOQI) 2009 and 2020 and KDIGO CKD 2024 guidelines as well as Pediatric Renal Nutrition Task Force clinical practice recommendations, to inform dietary management strategies for individuals across the lifespan living with CKD.

Keywords: Chronic kidney disease; Dietary management; Indian diet; Nutritional assessment; Pediatric CKD.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
Components of nutrition care process. Modified from reference 16.
Figure 2:
Figure 2:
Nutrition-focused examination signs for subcutaneous fat loss and muscle wasting in children with CKD. CKD: chronic kidney disease.
Figure 3:
Figure 3:
Recommended tools for nutrition assessment in CKD across the spectrum of childhood and adulthood. Modified from reference 20. CKD: chronic kidney disease, *: maintenance hemodialysis.
Figure 4:
Figure 4:
Various sources of high potassium diet and alternative lower potassium foods.
Figure 5:
Figure 5:
Phosphorus pyramid. Adapted from reference 28.
Figure 6:
Figure 6:
Potassium content in various food sources from an Indian diet. *: Uncooked food item.
See this image and copyright information in PMC

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