THE ROLE OF NUTRITIONAL INTERVENTIONS AND SUPPLEMENTATION IN CHRONIC KIDNEY DISEASE – A NARRATIVE REVIEW

Zofia Jedra; Maciej Czapiuk; Maciej Jakub Kozicki; Damian Zienkiewicz; Julia Maria Kostro; Gabriela Makulec; Karolina Domosud; Anna Libera; Karolina Bartkiewicz; Lizaveta  Novik

doi:10.31435/ijitss.2(50).2026.5309

Authors

Zofia Jedra Samodzielny Publiczny Szpital Kliniczny im. prof. W. Orłowskiego CMKP, Czerniakowska 231, 00-416 Warsaw, Poland https://orcid.org/0009-0000-5449-9546
Maciej Czapiuk Medical University of Warsaw (WUM), 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland https://orcid.org/0009-0007-8675-2180
Maciej Jakub Kozicki Medical University of Warsaw (WUM), 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland https://orcid.org/0009-0000-1966-0306
Damian Zienkiewicz Szpital Praski pw. Przemienia Pańskiego, Solidarności 67, 03-401 Warsaw, Poland https://orcid.org/0009-0008-7263-1545
Julia Maria Kostro Stefan Żeromski Specialist Hospital, Osiedle na Skarpie 66, 31-913 Kraków, Poland https://orcid.org/0009-0006-3455-2825
Gabriela Makulec Wojskowy Instytut Medyczny, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0009-1357-1340
Karolina Domosud Wojskowy Instytut Medyczny, Szaserów 128, 04-141 Warsaw, Poland https://orcid.org/0009-0007-4345-2188
Anna Libera Wojewódzki Szpital Zespolony w Kielcach, Grunwaldzka 45, 25-736 Kielce, Poland https://orcid.org/0009-0000-6806-3014
Karolina Bartkiewicz Medical University of Warsaw (WUM), 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland https://orcid.org/0009-0009-3082-7272
Lizaveta Novik Medical University of Warsaw (WUM), 61 Żwirki i Wigury Street, 02-091 Warsaw, Poland https://orcid.org/0009-0000-2181-2284

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5309

Keywords:

Chronic Kidney Disease, Nutrition Therapy, Low-Protein Diet, Plant-Based Diet, Ketoanalogues

Abstract

Background: Chronic kidney disease (CKD) affects approximately 10% of the population and is associated with increased cardiovascular risk and mortality. In advanced stages, protein-energy wasting (PEW) and malnutrition-inflammation complex syndrome (MICS) are common and worsen clinical outcomes. Evidence suggests that nutritional interventions, including modification of protein, sodium, potassium, and phosphorus intake, and selected supplementation, may slow CKD progression and reduce metabolic complications.

Aim: This review summarizes current evidence on nutritional interventions and supplementation in CKD, considering disease stage and treatment modality, and identifies gaps requiring further research.

Materials and methods: A narrative review of international guidelines (KDIGO, KDOQI, ESPEN) and clinical trials and meta-analyses published between 2009-2026, identified through searches of PubMed, Cochrane Library, Scopus, and Google Scholar, focusing on CKD stages G3-G5.

Results: Individualized protein restriction, sodium limitation, and qualitative phosphorus control improve metabolic parameters, blood pressure and albuminuria. Low- and very low-protein diets, particularly with amino acid ketoanalogue supplementation, are associated with slower CKD progression and a delayed initiation of renal replacement therapy. Plant-based diets may additionally improve acid-base balance, phosphate metabolism, and inflammation. The strongest evidence for supplementation concerns vitamin D, iron, and amino acid ketoanalogues, while data on omega-3 fatty acids, probiotics, and B vitamins remain inconclusive.

Conclusions: Nutritional management is a key component of CKD care. Individualized dietary strategies and targeted supplementation may provide nephroprotective and metabolic benefits, although further high-quality randomized trials are needed to confirm effects on hard clinical endpoints.

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