ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

Enrico Fiaccadori, Alice Sabatino, Rocco Barazzoni, Juan Jesus Carrero, Adamasco Cupisti, Elisabeth De Waele, Joop Jonckheer, Pierre Singer, Cristina Cuerda

Research output: Contribution to journalArticlepeer-review


Acute kidney disease (AKD) - which includes acute kidney injury (AKI) – and chronic kidney disease (CKD) are highly prevalent among hospitalized patients, including those in nephrology and medicine wards, surgical wards, and intensive care units (ICU), and they have important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, whatever is the modality used, the possible impact on nutritional profiles, substrate balance, and nutritional treatment processes cannot be neglected. The present guideline is aimed at providing evidence-based recommendations for clinical nutrition in hospitalized patients with AKD and CKD. Due to the significant heterogeneity of this patient population as well as the paucity of high-quality evidence data, the present guideline is to be intended as a basic framework of both evidence and - in most cases - expert opinions, aggregated in a structured consensus process, in order to update the two previous ESPEN Guidelines on Enteral (2006) and Parenteral (2009) Nutrition in Adult Renal Failure. Nutritional care for patients with stable CKD (i.e., controlled protein content diets/low protein diets with or without amino acid/ketoanalogue integration in outpatients up to CKD stages four and five), nutrition in kidney transplantation, and pediatric kidney disease will not be addressed in the present guideline.

Original languageEnglish
Pages (from-to)1644-1668
Number of pages25
JournalClinical Nutrition
Issue number4
StatePublished - Apr 2021


  • Acute kidney disease
  • Acute kidney injury
  • Clinical nutrition
  • Enteral nutrition
  • Hospitalized patients
  • Intensive care unit
  • Kidney replacement therapy
  • Malnutrition
  • Muscle wasting
  • Parenteral nutrition


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