National Kidney Foundation Releases K/DOQI Nutrition Guidelines for Dialysis Patients

New York, NY
June 12, 2000

In an effort to improve the nutritional status of dialysis patients in the United States, the National Kidney Foundation (NKF) has released the K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, a set of recommendations for the nutritional care of individuals receiving chronic dialysis treatment. The result of a two-year effort of a multidisciplinary work group, the guidelines provide recommendations for evaluating protein-energy nutritional status and for prescribing the appropriate levels of dietary energy and protein intake for children and adults with chronic renal failure. The nutrition guidelines are part of NKF’s Kidney Disease Outcomes Quality Initiative, or K/DOQI, a patient outcomes program that seeks to improve clinical practice in all phases of kidney disease and dysfunction.

“Nutrition is critical in determining the success of outcomes in patients receiving dialysis treatment,” says Joel Kopple, MD, president of the National Kidney Foundation and chair of the Nutrition Work Group. “These guidelines were developed with the hope that the recommendations for patient management and for future research and the information they provide will improve the nutritional status of individuals receiving chronic dialysis therapy, and thereby improve their health, survival rates and overall quality of life.”

The guidelines, which were developed based on a structured review of both medical literature and expert opinion, comprise separate recommendations for adult and pediatric patients. The guidelines for children receiving dialysis also address the dietary needs for vitamins, zinc and copper as well as treatment with recombinant human growth hormone. They also provide recommendations regarding the nutritional intake of L-carnitine for adult patients, the nutritional management of non-dialyzed adults with advanced chronic renal insufficiency and the management of acutely ill pediatric and adult patients.

Key guidelines for protein and energy intake are:

• Optimal protein intake for adults on hemodialysis is 1.2 grams per kilogram of body weight per day. The initial dietary protein intake for children being treated with maintenance hemodialysis should be based on the RDA for their chronological age plus an additional 0.4 g/kg per day.
• Optimal protein for adult chronic peritoneal dialysis patients is 1.2 to 1.3 grams per kilogram of body weight per day. The initial dietary protein intake for children being treated with maintenance peritoneal dialysis should be based on the RDA for their chronological age plus an additional increment based upon anticipated peritoneal losses.
• The recommended daily energy intake for adult patients on maintenance hemodialysis or chronic peritoneal dialysis is 35 kilocalories/kg of body weight per day for those under age 60, and 30 to 35 kilocalories/kg body weight per day for individuals 60 and older.

For adult maintenance dialysis patients, the guidelines maintain that nutritional status be routinely assessed by predialysis or stabilized serum albumin, percent of usual body weight, percent of standard (NHANES II) body weight, subjective global assessment, dietary interviews and diaries and nPNA (normalized protein equivalent of total nitrogen appearance). The guidelines also recommend that these assessments be done routinely because they provide a valid and clinically useful characterization of the protein-energy nutritional status of maintenance dialysis patients.

More than 260,000 Americans currently suffer from chronic kidney failure, a condition that requires dialysis or transplantation for survival. Each year, nearly 50,000 Americans die from causes related to the disease. Diabetes mellitus and hypertension are the two leading causes of kidney disease, accounting for 40 and 26 percent of new cases each year.

To purchase the Clinical Practice Guidelines for Nutrition in Chronic Renal Failure or for more information about kidney disease and nutrition, contact the National Kidney Foundation’s Materials Department at (800) 622-9010, extension 175.