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Cited by 277Clinical Nutrition and GastroenterologyDialysis and Renal Disease ManagementAcute Kidney Injury Research

ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

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Fiaccadori, Enrico, Sabatino, Alice, Barazzoni, Rocco, Carrero, Juan Jesus, Cupisti, Adamasco, De Waele, Elisabeth, Jonckheer, Joop, Singer, Pierre +1 more·2021·Clinical Nutrition
DOI 10.1016/j.clnu.2021.01.028
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Abstract

Acute kidney disease (AKD) - which includes acute kidney injury (AKI) - and chronic kidney disease (CKD) are highly prevalent among hospitalized patients, including those in nephrology and medicine wards, surgical wards, and intensive care units (ICU), and they have important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, whatever is the modality used, the possible impact on nutritional profiles, substrate balance, and nutritional treatment processes cannot be neglected. The present guideline is aimed at providing evidence-based recommendations for clinical nutrition in hospitalized patients with AKD and CKD. Due to the significant heterogeneity of this patient population as well as the paucity of high-quality evidence data, the present guideline is to be intended as a basic framework of both evidence and - in most cases - expert opinions, aggregated in a structured consensus process, in order to update the two previous ESPEN Guidelines on Enteral (2006) and Parenteral (2009) Nutrition in Adult Renal Failure. Nutritional care for patients with stable CKD (i.e., controlled protein content diets/low protein diets with or without amino acid/ketoanalogue integration in outpatients up to CKD stages four and five), nutrition in kidney transplantation, and pediatric kidney disease will not be addressed in the present guideline.

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  • For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m2) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.

    “For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m 2 ) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [88]

    Recommendation 18 supports 0.8 g/kg body weight/day as the upper end of a 0.6–0.8 g/kg/day range for hospitalized patients with CKD without acute or critical illness. It does not set 0.8 g/kg/day as a target for all polymorbid inpatients at nutritional risk with eGFR <30 who are not on kidney replacement therapy; it recommends higher intakes for patients with acute or critical illness. (LLM, conf=0.87)

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Authors
Fiaccadori, E., Sabatino, A., Barazzoni, R., Carrero, J. J., Cupisti, A., De Waele, E., Jonckheer, J., Singer, P., & Cuerda, C.
Affiliations
  • University of Parma (IT)
  • University of Trieste (IT)
  • University of Pisa (IT)
  • Universitair Ziekenhuis Brussel (BE)
  • Tel Aviv University (IL)
  • Hospital General Universitario Gregorio Marañón (ES)
Corresponding author
Fiaccadori, Enrico
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2021-04
Volume
40
Issue
4
Pages
1644-1668
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2021.01.028
OpenAlex
W3126596162
Cited by
277
References
30
Citations by year
2026: 48 · 2025: 50 · 2024: 55 · 2023: 73 · 2022: 34 · 2021: 17
FWCI
28.55
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
Keywords
acute kidney injury, chronic kidney disease, hospitalized patients, enteral nutrition, parenteral nutrition, renal replacement therapy, dietary management, low-protein diet, amino acid therapy
MeSH terms
Acute Disease, Europe, Hospitalization, Humans, Inpatients, Kidney Diseases, Nutritional Status, Nutritional Support, Renal Insufficiency, Chronic

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