Manual of Clinical Nutrition

Medical Nutrition Therapy for Chronic Kidney Disease

Manual of Clinical Nutrition Management G- 15 Copyright © 20 13 Compass Group, Inc.

Table G-3: Daily Nutritional Requirements for Adults with Renal Disease Based on

Type of Therapy

Diagnosis/

Therapy

Energy Protein Fluid Sodium Potassium Phosphorus

Acute kidney
injury (5)

25 - 35

kcal/kga, or

determine

via indirect

calorimetry

Consider

stress level.

Include

energy from

continuous

RRT, if

applicable.

0.8-1.2 g/kga

with no

dialysis

1.2-1.5 g/kga

with dialysis

or if catabolic

Anuric/

oliguric

phasec: 500

mL + total

output (urine,

vomitus, and

diarrhea)

Diuretic phase:

Large volume

of fluids may

be needed.

Assess

frequently.

Anuric/

oliguric phase:

2 - 3 g;

based on blood

pressure and

edema

Diuretic phase:

Replace based

on urine

output, edema,

need for

dialysis, and

serum sodium

levels.

Anuric/oliguric

phase:

2 - 3 g

Diuretic phase:

Replace losses

depending on

urine volume,

serum potassium

levels, and need for

dialysis and

medication.

8 to 15 mg/kga

Individualize based on

serum values.

Stage 1- 4
CKD (1)

23 - 35

kcal/kga

(Grade II)(1)^

30 - 35

kcal/kga if

>60 years old

(6,14)

0.6-0.8 g/kga

without

diabetes

(Grade^ II)(1)^

0.8-0.9 g/kga^

with diabetic

nephropathy

(Grade II)(1)

Individualize

to maintain

appropriate

hydration

status.

Individualize or

<2.4 g (Grade II)^

(1)

Individualize

based on

laboratory values.

If hyperkalemia,

<2.4 g (for stages 3

and 4) (Grade II)1)

Based on serum value

For stages 3 and 4, 800-

1,000 mg or 10-12 mg/g of

protein (Grade II)(1)

Dose and timing of
phosphate binders
individualized (Grade IV)(2)
Stage 5 CKD/
Hemodialysis
(5,6,9,14)

35 kcal/kga^

<60 years old

30 - 35

kcal/kga if

>60 years old

>1.2 g/kga^

with >50%

HBVb

Urine output

+ 1,000 mL

1,000-1,500

mL if anuric

Individualize or

2 g

2 - 3 g

Individualize

based on

laboratory values.

Individualize, or

<10-12 mg/kga or 800-

1,000 mg when serum

phosphorus levels

approach the upper limit

of normal range (2)

Usually requires

phosphate binder (9)

Stage 5 CKD/
Peritoneal
dialysis
(5,6,9,14)

35 kcal/kga

30 - 35

kcal/kga if

>60 years old

Subtract

energy

absorbed

from

dialysate

from daily

energy

prescription.

1.2-1.3 g/kga^

with >50%

HBVb^

Individualize

to maintain

fluid balance

and blood

pressure.

Individualize or

2 g

3 - 4 g

Adjust to serum

levels.

Individualize, or

<10-12 mg/kga or 800-

1,000 mg when serum

phosphorus levels

approach the upper limit

of the normal range (2)

Usually requires

phosphate binder (9)

aTo calculate these requirements, use standard body weight derived from the NHANES II weight table based on sex, age, and frame size. (See

Section II: Standard Body Weight (SBW) Determination Based on NHANES II.) In some cases, actual body weight or adjusted dry weight may be

more appropriate than standard body weight (152). In all cases, individual practitioners should use their own clinical judgment and expertise in

selecting a method (1,2,5,9).

bHBV, high–biological value protein

cAnuric/oliguric phase refers to less than 500 mL of urine output per 24 hours (1,14).