Pharmacist-Led Dietary Guidance Supports Kidney Health

Delivering and adhering to a quality-oriented diet can be beneficial for patients with chronic kidney disease (CKD) when implemented successfully. In a review published in Nature Reviews Nephrology, authors describe a framework that requires patients to consider both CKD-specific and general dietary factors, as well as potential barriers, challenges, and behavioral determinants of dietary choices and habits that may arise.¹

Why Are Diet and Healthy Eating Important for Adults With CKD?

When kidneys are healthy, they are able to effectively balance salts and minerals within the blood. Patients with CKD do not have their blood filtered properly by their kidneys.²

Previously, traditional dietary advice for people living with CKD focused primarily on the quantity of energy and protein provided by the diet, as well as restricting the consumption of single micronutrients. However, the study authors explained that flaws in the assumptions that underlie this quantity-based approach have contributed to reexamination of medical nutrition therapy for kidney-related conditions, such as CKD. Shifts towards recommending more varied and liberalized plant-rich diets with a focus on the quality of diet are being made. The authors wrote that although clinical practice guidelines for patients with CKD have “cautiously acknowledged” this shift, there is less advice available on how to translate new knowledge into practical and feasible recommendations to effectively advise patients on which foods to eat.¹

How Does This Review Describe a Sufficient Diet for Patients With CKD?

In their review, the authors lay out a framework for the delivery of quality-oriented diet therapy for people with CKD based on the dietary principles of balance, variety, and moderation. Importantly, their approach requires patients and health care professionals to consider how foods are processed, prepared, and integrated into the diet.

The authors describe the following in their framework¹:

• Patients should adhere to the “traditional kidney diet,” which focuses on restricting the consumption of high-potassium fruit and vegetables, dairy products, whole grains, legumes, seeds, and nuts to reduce the risks of hyperkalemia and hyperphosphatemia. A high intake of animal-based protein foods is needed to reduce the risk of protein-energy wasting.
• A quality-oriented diet therapy that promotes dietary balance, variety, and moderation to ensure nutritional adequacy and prevent health problems (eg, dysglycemia, constipation, dyslipidemia) is crucial.
• Patients with CKD should be encouraged to consume a variety of foods within each food group, including whole fruits and vegetables, lean meat, fish and seafood, grains, and so on.
• Meal planning and choosing the right cooking methods can help patients with CKD achieve and remain adherent to a healthy and varied diet.
• Patients should substitute ultra-processed foods—particularly those with high levels of sodium, potassium, and phosphorus additives—with suitable alternatives (eg, minimally processed foods) that are prepared from scratch and integrated into the diet as balanced meals with appropriate portion sizes.
• Quality-oriented diet therapy should be flexible and tailored to each individual patient, taking into consideration their current diet and the behavioral determinants of their dietary choices and habits.

CKD requires nutritional needs to change. Pharmacists, other health care professionals, and dieticians can make recommendations for patients who are unsure what foods are best to integrate into their diet. These experts can help create an individualized diet plan for each patient with CKD, and pharmacists especially are crucial in being an accessible educator and advocate for patients. Through ongoing counseling, pharmacists can also support meal planning, label interpretation, and behavior change, helping patients adopt flexible, sustainable diets that align with both clinical goals and everyday living.^1,2

REFERENCES

1. Carrero JJ, St-Jules DE, Biruete A, et al. Quality-oriented diet therapy for chronic kidney disease. Nat Rev Nephrol (2026). doi:10.1038/s41581-025-01034-0

2. Healthy eating for adults with chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed January 8, 2026. https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/healthy-eating-adults-chronic-kidney-disease