Strategies for setting medical nutrition therapy priorities for patients with stage 3 and 4 chronic kidney disease.
THE PROVISION OF medical nutrition therapy (MNT) for patients with early chronic kidney disease (CKD) has become more common since Medicare began reimbursing for this service in January 2002. This is good news for patients. It has been demonstrated that nutrition care for predialysis patients can improve survival during the first year of dialysis. Providing care for the patient with early CKD requires careful assessment and individualization of the nutrition intervention. Patients’ nutrition needs will vary depending on the etiology and stage of CKD, comorbidities, medications, and previous nutrition intake. The purpose of this article is to highlight the most common nutrition interventions for the CKD patient population. Secondly, this article aims to identify areas of confusion that frequently arise for this group of patients so that priorities for education can be properly determined. MNT for the CKD patient can address modifiable risk factors for CKD progression, which include hypertension, proteinuria, and hyperglycemia. Additionally, MNT can help to ameliorate metabolic alterations, such as secondary hyperparathyroidism and metabolic acidosis, and help to prevent protein-energy wasting.