Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.
Guidelines
No recommendations possible based on Level I or II evidence
Suggestions for Clinical Care
(Suggestions are based on Level III and IV evidence)
- Priority should be given to a diet aimed at avoidance of protein-energy malnutrition, and reducing fat intake to less than 30% of daily energy intake, with the saturated component limited to 10%. Carbohydrates should be used to make up the balance of the required daily energy intake. (Opinion)
Early referral to a dietician skilled in renal care is recommended. The renal dietician should provide a tailored and balanced diet addressing the patient's energy requirements, protein limitations, and lipid/fat calorie intake for general health, along with the carbohydrate intake. The mix of carbohydrate intake may vary between individual patient groups (e.g., diabetes mellitus patients).
The nephrologist at the time of referral should recommend to the dietician any special requirements for the individual patient (e.g., cholesterol limits in coronary artery disease) along with protein intake. Attainment of an ideal body weight (as assessed by body mass index [BMI]) may need addressing concurrently.
Definitions:
Levels of Evidence
Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)
Level II: Evidence obtained from at least one properly designed RCT
Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group
Level IV: Evidence obtained from case series, either post-test or pretest/post-test
