Enfermedad renal crónica (no diálisis)

Why / when / how

Nutritional intervention in people with chronic kidney disease without dialysis may slow the progression toward end-stage kidney disease, above all in the advanced stages, with a very low protein diet and under specialized supervision. The certainty of the evidence is moderate for that supervised strategy, but low when a low protein diet is compared with the usual protein intake, and the benefit is uncertain in the mild forms. This is why the recommendation is conditional in favor: in advanced disease the balance is favorable, although the risk of protein-energy malnutrition and the lower certainty in the remaining scenarios must be weighed.

Cautions

Before indicating nutritional changes, assess the patient's nutritional status, comorbidities, and treatments, and individualize the intervention according to their clinical condition. Carry out a screening for eating disorders and consider the possible interactions between food and the medications in use. Advise seeking professional assessment if any of these warning signs appear: involuntary weight loss, persistent digestive symptoms, decompensation of an underlying disease; and refer to a nutrition professional; where more appropriate, to the corresponding specialist when the situation requires it. Reassess the response and the tolerance periodically.

Quantitative evidence