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The clinical practice guidelines (CPGs) for nutrition in chronic kidney disease (CKD) were updated after 20 years from the previous guidelines by the Kidney Disease Outcomes Quality Initiative (KDOQI). During this period, the severity of CKD was defined by eGFR and albuminuria by the organization Kidney Disease: Improving Global Outcomes (KDIGO). Main risk factors for CKD such as hypertension, hyperlipidemia, obesity, metabolic syndrome, and diabetes mellitus are closely related to lifestyle. Nutritional management is important to prevent and retard the progression of CKD. Members of the International Society of Renal Nutrition and Metabolism (ISRNM) reviewed the KDOQI CPG draft. ISRNM is an international scientific society comprising members of multiple subspecialties. ISRNM proposed the medical term protein-energy wasting (PEW), which is a keyword in renal nutrition. The prevalence of PEW among dialysis patients is high. The success of dietary therapy depends on adherence to the diet. It has to be palatable, otherwise eating habits will not change. To prevent the development and progression of CKD and PEW, regular consultation with an expert dietitian is required, especially regarding salt and protein restriction. Our cluster-randomized trial showed that intervention by a dietician was effective at retarding the progression of stage 3 CKD. In this review, I focus on salt (sodium) restriction and introduce tips for salt restriction and Japanese kidney-friendly recipes. Due to the lack of randomized controlled trials, nutritional management of CKD inevitably relies on expert opinion. In this regard, well-designed observational studies are needed. Too strict salt restriction may decrease quality of life and result in PEW.

It is known that there are distinct regional differences in the incidence and prevalence of dialysis, as well as the survival of dialysis patients in Japan. We investigated the relationship between diet, the level of exercise, and the incidence of dialysis due to diabetes mellitus (DM) and chronic glomerulonephritis (CGN). We also investigated the influence of access to full-time and part-time dieticians at dialysis centers on survival. We used data for the 47 prefectures of Japan from the National Nutrition Survey 1995-99 (n=38,003) and the Japanese Society for Dialysis Therapy 2005-07 (n=45,033). The impact of each factor was assessed by univariate regression analysis. Univariate analysis showed that body mass index (BMI) (r=0.296, p=0.022), intake of fish and shellfish (r=−0.254, p=0.043), and the intake of meat (r=0.275, p=0.031) were correlated with the incidence of new patients starting dialysis due to DM. In addition, the BMI (r=0.355, p=0.014), number of steps walked daily (r=−0.358, p=0.014), intake of green and yellow vegetables (r=−0.424, p=0.003), intake of fish and shellfish (r=−0.358, p=0.014), and intake of milk (r=−0.529, p

Better nutritional status and early initiation of dialysis had been considered one of the most important methods for better prognosis of dialysis patients. In this study, we analyzed the effects of nutritional status, renal function at the start of renal replacement therapy (RRT), and co morbidity on 12-month survival of ESRD patients. The subjects in this study were 9695 new ESRD patients who started RRT in 2007 in Japan. The average age of the subjects was 67.5 years, 64.1% of the subjects were male, and 42.9% had diabetes. During the 12-month period after the start of RRT, 1546 patients died, and 35 patients received renal transplantation. Average estimated glomerular filtration rate (eGFR) at the initiation of dialysis was 6.52+ 4.20 mL/min/1.73 m2. Average serum albumin was significantly higher (P