Table 5

Macronutrient recommendations in DKD

OrganizationLower ranges of dietary protein intakeHigher ranges of dietary protein intakeCarbohydrateFatty acidsSodium
KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease (22)0.8 g protein/kg/day in adults with diabetes and GFR <30 mL/min/1.73 m2 with appropriate educationAvoid protein intake >1.3 g/kg/day in adults with CKD at risk for progression; specific comment for DKD not providedSpecific recommendation not providedSpecific recommendation not providedLower salt intake to <2 g of sodium per day (5 g of sodium chloride), unless contraindicated
KDOQI 2007 Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease (4)Recommended dietary allowance of 0.8 g/kg body weight per day for people with DKD and CKD stages 1–4Avoid high-protein diets defined as ≥20% of total daily caloriesSpecific recommendation not providedIncrease intake of omega-3 and omega-9 fatty acidsReduction of intake 2.3 g/day as recommended by the DASH diet
ADA Standards of Medical Care in Diabetes—2014 (20) and Nutrition Therapy Recommendations for the Management of Adults With Diabetes (136)Maintain usual level of dietary protein intake (136); approximated by reported studies surveying diet intake in people with diabetes to be approximately 16–18% of total calories (20)Specific comment not providedSpecific recommendation for DKD not provided. For diabetes, include carbohydrates from vegetables, fruits, whole grains, legumes, and dairy products over intake from carbohydrates containing added sugar, fat, and sodium. Avoid beverages, products with high-fructose corn syrup, and sucroseTotal fat: individualizedSpecific recommendation for DKD not provided
Omega-3: same recommendation as for general public. Cholesterol, saturated, trans fats: same as for general publicFor individuals with diabetes, reduce sodium to <2,300 mg/day as recommended for the general public
Mono- and polyunsaturated fats: integrated to comment regarding potential benefits of a Mediterranean diet pattern