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Dietary Approaches in the Management of Diabetic Patients with Kidney Disease

Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA 92868, USA
Department of Internal Medicine, Korea University, School of Medicine, Seoul 08308, Korea
Department of Medicine, Tibor Rubin Veteran Affairs Health System, Long Beach, CA 90822, USA
Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA
Sierra Nevada Nephrology Consultants, Reno, NV 89511, USA
Department of Internal Medicine, University of Nevada Reno, School of Medicine, Reno, NV 89557, USA
Author to whom correspondence should be addressed.
Nutrients 2017, 9(8), 824;
Received: 5 July 2017 / Revised: 22 July 2017 / Accepted: 25 July 2017 / Published: 31 July 2017
(This article belongs to the Special Issue Nutrition and Chronic Kidney Disease)
Chronic kidney disease (CKD) is one of the most prevalent complications of diabetes, and patients with diabetic kidney disease (DKD) have a substantially higher risk of cardiovascular disease and death compared to their non-diabetic CKD counterparts. In addition to pharmacologic management strategies, nutritional and dietary interventions in DKD are an essential aspect of management with the potential for ameliorating kidney function decline and preventing the development of other end-organ complications. Among DKD patients with non-dialysis dependent CKD, expert panels recommend lower dietary protein intake of 0.8 g/kg of body weight/day, while higher dietary protein intake (>1.2 g/kg of body weight/day) is advised among diabetic end-stage renal disease patients receiving maintenance dialysis to counteract protein catabolism, dialysate amino acid and protein losses, and protein-energy wasting. Carbohydrates from sugars should be limited to less than 10% of energy intake, and it is also suggested that higher polyunsaturated and monounsaturated fat consumption in lieu of saturated fatty acids, trans-fat, and cholesterol are associated with more favorable outcomes. While guidelines recommend dietary sodium restriction to less than 1.5–2.3 g/day, excessively low sodium intake may be associated with hyponatremia as well as impaired glucose metabolism and insulin sensitivity. As patients with advanced DKD progressing to end-stage renal disease may be prone to the “burnt-out diabetes” phenomenon (i.e., spontaneous resolution of hypoglycemia and frequent hypoglycemic episodes), further studies in this population are particularly needed to determine the safety and efficacy of dietary restrictions in this population. View Full-Text
Keywords: diabetes; kidney disease; nutrition; diet diabetes; kidney disease; nutrition; diet
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Ko, G.J.; Kalantar-Zadeh, K.; Goldstein-Fuchs, J.; Rhee, C.M. Dietary Approaches in the Management of Diabetic Patients with Kidney Disease. Nutrients 2017, 9, 824.

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