Registered Dietitian Nutritionists and Medical Nutrition Therapy

Nutrition education in chronic kidney disease (CKD) care is traditionally focused on limiting nutrients such as protein, potassium, and phosphate, rather than incorporating nutritious foods to improve overall diet quality. This emphasis results in restricting fruits and vegetables, which directly contradicts updated nutrition recommendations for CKD. Recent CKD guidelines encourage more plant-forward eating patterns, such as the Mediterranean diet, eating more fruits and vegetables, and limiting potassium and phosphorus additives in ultra-processed foods. Diet changes focused on improving overall diet quality can help slow the progression of CKD, manage comorbid conditions such as diabetes, hypertension, obesity, and hyperlipidemia, and help control edema and electrolyte abnormalities. Registered dietitian nutritionists (RDNs) offer medical nutrition therapy (MNT), which includes a comprehensive nutrition assessment including factors such as medical history, labs, medications, food access, and food preferences. Importantly, MNT also includes nutrition counseling and education, which can improve adherence to nutrition recommendations. MNT administered by an RDN should be standard of care for all people with CKD. MNT is especially important for patients with, or at risk for protein energy wasting, when conservative care is implemented for management of kidney failure, and for those desiring weight loss or gain. Working with an RDN is especially important if weight loss strategies include use of a glucagon like peptide 1 agonist with or without a glucose dependent insulinotropic peptide 1. These drugs promote weight loss and have metabolic benefits, but the anorexic effects may lead to inadequate protein and/or micronutrient intake. Use of MNT can also empower patients who are motivated to implement dietary changes. Unfortunately, MNT remains underutilized, despite full coverage by most insurance policies in the United States, including Medicare. Increasing utilization of MNT may enhance the quality of care delivered for patients with CKD and improve outcomes.