Nutrition in the Elderly Patient with CKD

A large proportion of the elderly population suffers from chronic kidney disease (CKD). Emerging data demonstrate the importance of nutritional and dietary management in elderly adults with CKD because of their predisposition to age-related physiological changes that affect appetite and oral intake, including decreased digestive function, hormonal changes, altered smell, taste and vision, and post-prandial energy or nutrition utilization efficacy. Elderly patients with non-dialysis dependent CKD should be informed that they have a higher risk of cardiovascular death than kidney failure and this discussion may facilitate informed decision making for better health-related quality of life. Nutritional management constitutes one of the main therapeutic methods among patients with CKD. Optimizing the intake of energy, protein (i.e., low protein diet of 0.6–0.8 g/kg/day with >50% from plant sources or very low protein diets of <0.45 g/kg/day supplemented with essential amino acids or their keto-analogs), potassium, phosphorus, fiber, and sodium may be an effective strategy to preserve kidney function and delay or avoid the need for kidney replacement therapy in older patients, while also closely monitoring for the development of protein-energy wasting (PEW). A tailored precision nutrition and functional nutrition approach with a plant-dominant low-protein diet that maintains adequate energy intake, nitrogen balance, and mineral consumption may ameliorate kidney function decline while also preventing the development of PEW in older adults with CKD.