Malnutrition is common in CKD; as eGFR declines, so may appe-tite. Malnutrition in CKD patients is associated with increased morbidity and mortality.
Manage with adequate calories and nutrients.
A low protein diet (0.6 g/kg) may require supplemental riboflavin and cyanocobalamin. Supplemental pyridoxine may be beneficial due to medication-vitamin interactions.
It may be prudent to provide adequate amounts of thiamin and folic acid. High doses of vitamin C are not recommended. Data do not support routine supplementation with niacin and vitamins A, E, and K. In advanced CKD, certain vitamins may accumulate due to reduced excretion (Steiber & Kopple, 2011).