CKD Nutrition Reference Table

⚠️ IMPORTANT DISCLAIMER

This reference table is FOR EDUCATIONAL PURPOSES ONLY and DOES NOT replace professional medical advice.

The recommended values are GENERAL ESTIMATES from KDOQI 2020 Guidelines and clinical research. Each patient NEEDS a PERSONALIZED diet based on:

Blood tests: Urea, Creatinine, Potassium, Phosphorus, Albumin, HbA1c, PTH, Calcium
Clinical status: Edema, dyspnea, anemia, nutritional status
Comorbidities: Cardiovascular disease, diabetes, liver disease, inflammation
Current medications and drug-food interactions

MANDATORY to consult a nephrologist and renal dietitian before applying any changes!

Introduction

This reference table summarizes nutrition recommendations for CKD (Chronic Kidney Disease) patients from the KDOQI 2020 Clinical Practice Guideline for Nutrition in CKD - clinical guidelines developed by the National Kidney Foundation and Academy of Nutrition and Dietetics.

Values are classified by:

CKD Stage: CKD 1-2, CKD 3-5, Hemodialysis (HD), Peritoneal Dialysis (PD)
Urine Output Status: With urine (>500ml/day) vs Anuria (<100ml/day)
Nutritional Parameters: Energy, Protein, Sodium, Potassium, Phosphorus, Carbohydrate, Water

Nutrition Recommendations by CKD Stage

Stage	Energy (kcal/kg/day)	Protein (g/kg/day)	Sodium (mg/day)	Potassium (mg/day)	Phosphorus (mg/day)	Carbs (% energy)	Water (ml/day)	References
CKD 1-2	25-35 Age <60: 30-35 Age ≥60: 25-30	0.8-1.0 Normal level No restriction	<2000 If hypertension: <1500	2000-3500 No restriction if K level normal	<1400 Avoid high phosphorus foods	50-60% Prefer refined if CKD 2	1500-2500 As needed No restriction	[1][2]
CKD 3-5 (With urine)	25-35 30-35 if <60 years 25-30 if ≥60 years	0.6-0.8 ≥50% HBV protein (eggs, fish, meat)	<2000 Strict control <1500 if high BP	2000-3000 Adjust based on blood potassium	800-1000 IMPORTANT Use binders	50-60% Refined (white rice) not whole grain	1500-2500 Match urine output + 500-750ml	[1][3][4]
CKD 5 (Anuria/ <100ml/day)	25-35 Same as above Avoid PEW	0.6-0.8 Or VLPD 0.3-0.4 + ketoanalogues	<1500 VERY STRICT Avoid edema	1500-2000 STRICT LIMIT HyperK risk	800-1000 AVOID dairy, cola Binders mandatory	50-60% Refined Limit sugar	500-1000 STRICT Avoid overload	[1][5][6]
Hemodialysis (HD) With urine	30-35 Higher due to dialysis losses	1.0-1.2 INCREASE for losses ≥50% HBV	<2000 Control weight gain between sessions	2000-3000 Adjust per pre-dialysis K	800-1000 AVOID phosphorus Binders with meals	50-60% Energy from refined starch	1000-2000 = 24h urine output + 500-750ml	[1][7][8]
Hemodialysis (HD) Anuria	30-35 Same as above	1.0-1.2 Supplement post-HD	<1500 VERY STRICT High thirst	2000-2500 RESTRICTED Check pre-dialysis	800-1000 Phospho binders every meal	50-60% Refined	500-1000 EXTREMELY LIMITED Gain <2-2.5kg	[1][7][9]
Peritoneal Dialysis (PD) With urine	30-35 Minus glucose from dialysate	1.2-1.3 HIGHEST Loss via peritoneum	<2000 Control volume overload	2000-3000 More flexible than HD Per lab results	800-1000 Binders with meals	45-55% REDUCED due to glucose from PD fluid	1500-2000 = Urine output + 500ml	[1][10][11]
Peritoneal Dialysis (PD) Anuria	30-35 Minus PD glucose 150-300 kcal/day	1.2-1.3 Keep high Avoid PEW	<1500 STRICT Avoid overload	2000-2500 RESTRICTED Monitor frequently	800-1000 Phospho binders	45-50% Count PD glucose in total carbs	750-1500 RESTRICTED Per ultrafiltration	[1][10][12]

How to Use This Reference Table

Step 1: Determine your exact CKD stage (based on GFR from lab tests)
Step 2: Determine urine output status (measure 24-hour urine volume)
Step 3: Find the corresponding row in the table
Step 4: Calculate specific values based on your weight (example: if 70kg and protein 0.8g/kg → 56g protein/day)
Step 5: MOST IMPORTANT - Consult with doctor and dietitian to adjust these values
Note: These values need adjustment based on regular blood tests (urea, creatinine, potassium, phosphorus, albumin)

🧂 Sodium to Salt Conversion (NaCl)

Important note: Sodium (Na) and Table salt (NaCl) are DIFFERENT. Table salt contains approximately 40% Sodium and 60% Chloride.
Formula: Table salt (g) = Sodium (mg) × 2.5 ÷ 1000

Sodium (mg/day)	Equivalent table salt (g/day)
1000 mg	≈ 2.5 g
1500 mg	≈ 3.75 g
2000 mg	≈ 5 g
2300 mg	≈ 5.75 g
3000 mg	≈ 7.5 g
3500 mg	≈ 8.75 g
4000 mg	≈ 10 g

💡 Memory tip: 1 teaspoon of salt ≈ 6g salt ≈ 2400mg Sodium. CKD patients should stay below 1 teaspoon of salt per day!

Notes and Explanations

HBV Protein (High Biological Value): High biological value proteins like eggs, fish, lean meat, poultry - contain complete essential amino acids
VLPD (Very Low Protein Diet): Very low protein diet 0.3-0.4 g/kg/day combined with ketoanalogues of amino acids - only use under close supervision
Anuria: Urine output <100ml/day - requires strict water and potassium restriction
Weight gain between HD sessions: Target <2-2.5kg (equivalent to <5% dry weight) - exceeding causes volume overload
Glucose from PD fluid: Peritoneal dialysate contains glucose absorbed into the body (150-300 kcal/day) - must subtract from dietary intake
Phospho binders: Phosphate chelating medications (calcium carbonate, sevelamer, lanthanum) - MUST take with meals to be effective
Sodium <1500mg = <3.75g table salt: Very difficult to comply, requires specialized nutrition counseling
Protein-Energy Wasting (PEW): Common in CKD, adequate energy needed to prevent muscle loss and albumin decline

Scientific References

[1] Ikizler TA, et al. (2020). "KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update." American Journal of Kidney Diseases, 76(3 Suppl 1): S1-S107. doi:10.1053/j.ajkd.2020.05.006
PubMed | AJKD Full Text
*** Primary Reference - Latest Guidelines from National Kidney Foundation

[2] KDIGO (2021). "Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease." Kidney International, 99(3S): S1-S87. doi:10.1016/j.kint.2020.11.003
PubMed | Kidney Int | KDIGO Official

[3] Hahn D, Hodson EM, Fouque D. (2020). "Low protein diets for non-diabetic adults with chronic kidney disease." Cochrane Database of Systematic Reviews, 10: CD001892. doi:10.1002/14651858.CD001892.pub5
PubMed | Cochrane Library

[4] Ko GJ, Obi Y, Tortorici AR, Kalantar-Zadeh K. (2017). "Dietary protein intake and chronic kidney disease." Current Opinion in Clinical Nutrition and Metabolic Care, 20(1): 77-85. doi:10.1097/MCO.0000000000000342
PubMed | LWW Journal

[5] Garneata L, et al. (2016). "Ketoanalogue-Supplemented Vegetarian Very Low-Protein Diet and CKD Progression." Journal of the American Society of Nephrology, 27(7): 2164-2176. doi:10.1681/ASN.2015040369
PubMed | JASN | PMC Free

[6] Piccoli GB, Cederholm T, Avesani CM, et al. (2023). "Nutritional status and the risk of malnutrition in older adults with CKD." Clinical Nutrition, 42(4): 443-457. doi:10.1016/j.clnu.2023.01.018
PubMed | ScienceDirect

[7] Fouque D, Kalantar-Zadeh K, Kopple J, et al. (2008). "A proposed nomenclature and diagnostic criteria for protein-energy wasting in acute and chronic kidney disease." Kidney International, 73(4): 391-398. doi:10.1038/sj.ki.5002585
Kidney Int Full Text

[8] Cano NJ, Fouque D, Roth H, et al. (2007). "Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients." Journal of the American Society of Nephrology, 18(9): 2583-2591. doi:10.1681/ASN.2007020184
PubMed | JASN

[9] Palmer SC, Hanson CS, Craig JC, et al. (2015). "Dietary and fluid restrictions in CKD: a thematic synthesis of patient views." American Journal of Kidney Diseases, 65(4): 559-573. doi:10.1053/j.ajkd.2014.09.012
PubMed | AJKD

[10] Chung SH, Lindholm B, Lee HB. (2000). "Influence of initial nutritional status on CAPD patient survival." Peritoneal Dialysis International, 20(1): 19-26.
PubMed | SAGE Journals

[11] Dong J, Li Y, Xu Y, Xu R. (2011). "Daily protein intake and survival in patients on peritoneal dialysis." Nephrology Dialysis Transplantation, 26(11): 3715-3721. doi:10.1093/ndt/gfr142
PubMed | Oxford Academic

[12] Wang AY, Sanderson J, Sea MM, et al. (2003). "Important factors associated with inadequate dietary protein and energy intakes in peritoneal dialysis." American Journal of Clinical Nutrition, 77(4): 834-841. doi:10.1093/ajcn/77.4.834
PubMed | ScienceDirect

[13] Palmer SC, Maggo JK, Campbell KL, et al. (2017). "Dietary interventions for adults with chronic kidney disease." Cochrane Database of Systematic Reviews, 4: CD011998. doi:10.1002/14651858.CD011998.pub2
PubMed | Cochrane | PMC Free

[14] National Kidney Foundation. (2006). "K/DOQI Clinical Practice Guidelines 2006 Updates - Hemodialysis Adequacy, Peritoneal Dialysis Adequacy." American Journal of Kidney Diseases, 48(Suppl 1): S1-S322.
NKF KDOQI Portal