According to the recent estimates more than 40% of people with diabetes are at risk of developing CKD, with a significant proportion who will develop kidney failure requiring dialysis and/or kidney transplantation (KDIGO 2020 guidelines). 1 The two major risk factors for CKD and ESKD are diabetes mellitus and hypertension which are associated with obesity and metabolic syndrome and possibly lifestyle modification can provide potential benefits in managing these risk factors. 2
Nutrition Targets in DKD
Even though the nutrition targets for adults with diabetes and DKD are more or less same which include achieving normal blood glucose, blood lipids, and blood pressure levels, a healthy body weight and prevention of complications of diabetes; these targets are very difficult to achieve in persons with DKD due to complex inter-relationships between and effects of specific macronutrients and micronutrients on kidney function. This is imperative in managing patients with established CKD as those might require dietary modifications that are absolutely different from those required for primary prevention. 3
The dietary modifications for DKD are recommended for protein, carbohydrates, fat, and salt intake. A tailored approach in the form of a program for dietary interventions seems an appropriate option in these patients. The dietary modifications include a low protein diet and a dietary sodium restriction (less intake of salt) confers benefits in CKD patients with diabetes. A higher intake of fruits and vegetables can improve outcomes and reducing cardiovascular risk (improves heart health). 2
Diet concepts in patients with diabetes and CKD
Primary prevention by modifying lifestyle factors can reduce the risk of CKD
In a study conducted on adults (total 2,755,719 participants) who had reported lifestyle exposures (diet, physical activity, alcohol consumption), the following findings were reported: 4
Recommendations of KDIGO 2020 on lifestyle modifications in patients with diabetes and CKD
Physical activity recommendations
Key words: CKD: chronic kidney disease; CVD: cardiovascular disease; DKD: Diabetic Kidney Disease; ESKD: end-stage kidney disease; KDIGO: Kidney Disease Improving Global Outcomes
KDIGO 2020 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney International. 2020; 98, S1–S115.
Lees JS and Mark PB. Fruit for thought: lifestyle interventions to reduce the risk of future chronic kidney disease. Nephrol Dial Transplant.2020;1–3.
Goldstein-Fuchs J and Kalantar-Zadeh K. Nutrition Intervention for Advanced Stages of Diabetic Kidney Disease. Diabetes Spectr. 2015;28(3):181-6. doi: 10.2337/diaspect.28.3.181.
Kelly JT etal. Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta- Analysis. JASN.2021; 32 (1) 239-253.