Malnutrition is common, affecting up to 50 % of patients with renal disease. It has an adverse impact on mortality rates. Patients with CKD stages 4 or 5 often present with potassium and phosphate electrolyte imbalance which will require dietetic management. Patients on dialysis usually produce little or no urine and frequently require education in relation to fluid and sodium restriction to prevent fluid overload.

When CKD reaches stage 4 and 5. Other than advice to reduce sodium intake, most patients with CKD stage 3 do not require the expertise of a specialist renal dietician.

This will vary considerably both between and within patients as they move from pre-dialysis through peritoneal dialysis and haemodialysis to transplantation. It is likely however that specific dietary advice will be required in one or more of the following areas of nutritional intake:

Debate continues as to the optimal level of protein intake in stages 4–5. High protein diets should be avoided as they increase hyperfiltration, worsen proteinuria and speed the decline of renal function. There was once a vogue for low protein diets as a means of preventing uraemic symptoms in the run up to dialysis but this advice has long been abandoned as it only led to malnutrition. Currently, for patients not on dialysis a minimum daily protein of 0.75 g/kg ideal body weight is recommended.

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