Clinical Experiences and Open Issues in Multidisciplinary Dietary Management of CKD

Dear colleagues,

Chronic kidney disease (CKD) affects about 10% of the population worldwide, exerting a non-negligible impact on healthcare systems; high-income countries spend about 2%–5% of their total healthcare budget on renal replacement therapy. Among the therapies available to mitigate CKD progression and delay the need for renal replacement therapy, nutritional management plays a major role. The recently published update of the KDOQI guidelines on nutrition in CKD has highlighted the importance of diet and advises starting a low-protein diet as early as in CKD stage 3. However, some questions still remain unanswered.

Despite the now widely acknowledged safety and efficacy of a low-protein regimen, concerns still exist about the prescription of such a diet in specific populations. Some authors advise caution in prescribing a low-protein diet to elderly patients on account of the risk of malnutrition. Moreover, less is known in the paediatric or transplant populations. Other open issues include that of pregnant patients for whom a usual diet is rich in proteins. Similarly, in CKD patients practicing sport, nutritional needs should probably be tailored.

In addition to their quantity, the source of protein is also a matter of debate: should we prefer plant-based over animal-derived proteins?

Micronutrient needs and supplementation rely on the demonstration of an inadequate intake or deficiency, but this field is largely unexplored and the recent recommendations are based on “expert opinions” only.

Finally, food preservatives and additives are an almost unexplored field: they may contain not only large amounts of potassium and phosphate, not often disclosed, but also a vast array of potentially toxic substances whose role in the progression of CKD is unknown and could influence the morbidity of kidney disease.

This Special Issue of Nutrients is aimed at shedding some light on these open questions to improve our understanding of the role and limits of nutritional management in CKD. We welcome clinical investigations, laboratory research with translational potential as well as emblematic case studies and reviews that can be useful in everyday practice and above all, benefit our patients.

Prof. Dr. Domenico Santoro
Dr. Massimo Torreggiani
Guest Editors

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