Dietary recommendations for obese patients with chronic kidney disease

For optimal management of chronic kidney disease (CKD), dietary modification should be an integral part of patient care. Dietary considerations for obese patients with CKD are numerous and complicated and involve modification of intake of calories, protein, fat, phosphorus, and electrolytes. General principles for dietary management of obese patients include (1) ensuring adequate monitoring of nutritional status through assessment of diet, nutrition-related laboratory parameters, and anthropometrics; (2) creation of an individualized diet plan that meets clinical guidelines and has favorable effects on obesity-related conditions such as blood pressure and lipids; (3) careful attention to patients' food choices, portion size, and food-prepa ration methods; (4) recommending adjustment of overall energy intake to promote weight loss, yet maintain good nutritional status; and (5) modification of diet as the patient's nutritional status changes and CKD progresses. The basic objectives of dietary modification are to lighten the excretory load of products of metabolism and to help the kidney maintain normal equilibrium of the body's internal environment. Dietary modifications must be individualized and appropriate to the stage of CKD. This review describes dietary factors important in optimizing nutritional status of obese patients with CKD. Additionally, current clinical practice guidelines and strategies for meeting them are discussed. (c) 2006 by the National Kidney Foundation, Inc.