During progression of chronic kidney disease (CKD), the requirements and utilization of different nutrients change significantly. These changes ultimately place patients with kidney disease at higher risk for nutritional and metabolic abnormalities. Understanding the applicable nutritional principles, the available methods for assessing nutritional status, establishing patient-specific dietary needs, and preventing or treating potential or ongoing nutritional deficiencies and derangements is therefore essential for optimal care of the patients with CKD.

Oral nutritional supplementation with Nepro®, as part of a structured, directly observed peridialytic therapy in chronic hemodialysis patients was well-accepted, and resulted in the maintenance of serum albumin levels and QOL, with respect to impact of physical health on daily activities

The International Society of Renal Nutrition and Metabolism set up a panel to define nomenclature for the wasting syndrome, as distinct from malnutrition and inflammation, associated with chronic kideny disease (CKD) and acute kideny injury (AKI)

In adults with CKD 3-5D or posttransplantation, it is reasonable that a registered dietitian nutritionist (RDN) or an international equivalent conduct a comprehensive nutrition assessment (including but not limited to appetite, history of dietary intake, body weight and body mass index, biochemical data, anthropometric measurements, and nutrition-focused physical findings) at least within the first 90 days of starting dialysis, annually, or when indicated by nutrition screening or provider referra

Hyperleptinemia reflects better nutritional status and rHuEPO response in long-term HD patients. Increasing energy intake through high-energy, high protein renal-specific supplements (Nepro®) improves erythropoiesis, which may be mediated in part by an increase in serum leptin levels.

Maintenance hemodialysis patients with albumin levels < 3.5 g/dL who received monitored intradialytic oral nutritional supplements showed survival significantly better than similar matched patient controls, with the as-treated analysis highlighting the potentially large effect of this strategy in clinical practice