A Delphi consensus panel on nutritional therapy in chronic kidney disease.
The conservative management of chronic kidney disease (CKD) includes nutritional therapy (NT) with the aim to reduce the intake of proteins, phosphorus, organic acids, sodium, and potassium, while ensuring adequate caloric intake. While there is evidence that NT may help to prevent and control metabolic alterations in CKD, the criteria for implementing a low-protein regimen in CKD are still debated. There is no final consensus on the composition of the diet, nor indications for specific patient settings or different stages of CKD. Also when and how to start dietary manipulation of different nutrients in CKD is not well defined. A group of Italian nephrologists participated, under the auspices of the Italian Society of Nephrology, in a Delphi exercise to explore the consensus on some open questions regarding the nutritional treatment in CKD in Italy, generating a consensus opinion for 23 statements on: (1) general principles of NT; (2) indications for and initiation of NT; (3) role of protein-free products; (4) NT safety; (5) integrated management of NT. This Delphi exercise shows that there is broad consensus regarding NT in CKD across a wide range of management areas. These clinician-led consensus statements provide a framework for appropriate guidance on NT in patients with CKD, and are intended as a guide in decision-making whenever possible.
Division of Nephrology, Dialysis and Transplantation, Salerno Medical School, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Via San Leonardo, 84131, Salerno, Italy. vincenzo.bellizzi@tin.it.
Vincenzo
V
Bellizzi
Unità Operativa Nefrologia, Ospedale San Donato, Arezzo, Italy.
Stefano
S
Bianchi
Nephrology and Dialysis Unit, ASL 8 Cagliari, Cagliari, Italy.
Piergiorgio
P
Bolasco
Nephrology and Dialysis Unit, Santa Chiara Hospital, Trento, Italy.
Giuliano
G
Brunori
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Adamasco
A
Cupisti
Division of Nephrology and Dialysis, School of Medicine Rome, Columbus-Gemelli Hospital Catholic University, Rome, Italy.
Giovanni
G
Gambaro
Renal, Dialysis and Transplant Unit, Department of Emergency and Transplantation, University of Bari, Bari, Italy.
Loreto
L
Gesualdo
Unit of Nephrology and Dialysis, S. Giovanni Evangelista Hospital, Tivoli, Italy.
Pasquale
P
Polito
Department of Clinical and Experimental Medicine, AOU G Martino University of Messina, Messina, Italy.
Domenico
D
Santoro
Nephrology, Dialysis, Hypertension Unit, Teaching Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy.
Antonio
A
Santoro
D000066491:Clinical Decision-Making; D003697:Delphi Technique; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D004044:Dietary Proteins / Q000009:adverse effects*; D006801:Humans; D015596:Nutrition Assessment; D009752:Nutritional Status; D018579:Patient Selection; D011237:Predictive Value of Tests; D064167:Recommended Dietary Allowances; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000178:diet therapy* / Q000503:physiopathology; D012307:Risk Factors; D016896:Treatment Outcome
D004044:Dietary Proteins
Chronic kidney disease; Delphi consensus; Low-protein diet; Nutritional therapy; Phosphate; Salt