title: A practical approach to dietary interventions for nondialysis-dependent CKD patients: the experience of a reference nephrology center in Brazil.
abstract: This paper describes the 30-year experience on nutritional management of non-dialysis dependent chronic kidney disease (CKD) patients in a public outpatient clinic located in the city of São Paulo, Brazil. A team of specialized dietitians in renal nutrition is responsible to provide individual dietary counseling for patients on stages 3 to 5 of CKD. Two different types of nutrition care protocols are employed depending on the level of renal function. For patients with CKD stage 3 a simplified nutritional assessment is performed and the main dietary focus is on the control of protein intake particularly from animal sources. A more complete nutritional assessment as well as a detailed dietary plan focusing not only on the control of protein but also on energy supply and on specific micronutrients is provided for patients on stages 4 or 5 of CKD. Practical approaches and tools used by the dietitians in our clinic for improving patient´s adherence to protein, sodium and potassium restriction while maintaining a healthy diet are described in detail in the sections of the article.
authors.affiliation: Division of Nephrology and Nutrition Program, Federal University of São Paulo, and Oswaldo Ramos Foundation, Rua Pedro de Toledo, 282, São Paulo, 04039-000, Brazil. lcuppari@uol.com.br.
authors.forename: Lilian
authors.identifier: 0000-0002-5927-9179
authors.initials: L
authors.lastname: Cuppari
authors.affiliation: Division of Nephrology, Nutrition Department, Pro-rim Foundation, Joinville, Brazil.
authors.forename: Fabiana Baggio
authors.initials: FB
authors.lastname: Nerbass
authors.affiliation: Nutrition Institute, Rio de Janeiro State University, Rio de Janeiro, Brazil.
authors.forename: Carla Maria
authors.initials: CM
authors.lastname: Avesani
authors.affiliation: Nutrition Program and Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Ayako
authors.initials: MA
authors.lastname: Kamimura
mesh_terms: D000554:Ambulatory Care Facilities; D001938:Brazil; D004044:Dietary Proteins / Q000008:administration & dosage*; D004046:Dietetics; D037001:Directive Counseling; D002149:Energy Intake; D005919:Glomerular Filtration Rate; D006801:Humans; D018977:Micronutrients / Q000008:administration & dosage; D015596:Nutrition Assessment; D010348:Patient Care Team; D010349:Patient Compliance; D017419:Potassium, Dietary / Q000008:administration & dosage; D051437:Renal Insufficiency / Q000178:diet therapy* / Q000503:physiopathology*; D012720:Severity of Illness Index; D012982:Sodium, Dietary / Q000008:administration & dosage*
chemical_list: D004044:Dietary Proteins; D018977:Micronutrients; D017419:Potassium, Dietary; D012982:Sodium, Dietary
keywords: Brazil; Chronic kidney disease; Diet; Dietary protein