Tim Pflederer, MD, is the chief medical officer at Evergreen Nephrology

New Federal Dietary Guidelines Impact on Chronic Kidney Disease Management With Tim Pflederer, MD

The newly released 2025–2030 federal dietary guidelines for Americans may need careful interpretation for patients with 

, particularly regarding encouraged protein intake.

The guidelines, released by the U.S. Department of Health and Human Services (HHS), emphasize protein, recommend limiting processed foods, and encourage a shift toward whole foods. While these recommendations aim to promote general health in the American population, patients with CKD may require tailored guidance based on their kidney function and individual health status.

Ultimately, nephrologists play a key role in bridging the gap between generalized dietary guidelines and the specific needs of patients with CKD. Dietary management in CKD can also help prevent cardiovascular complications and aid in controlling hypertension and diabetes, common comorbidities. In addition, nutrition may influence how well treatments for kidney disease work. The American Kidney Fund recommends working with a dietitian to develop an individualized, kidney-friendly eating plan accounting for disease stage, comorbidities, and dialysis status.

“A diet that is predominantly plant-based is more protective for the kidneys than a meat-based diet,” said Tim Pflederer, MD, chief medical officer at Evergreen Nephrology in an interview with 

Most Americans consume diets heavily centered on meat, so nephrologists work with our patients to encourage moderation in protein intake and a focus on vegetarian or plant-focused protein sources.”

Excess protein intake, particularly from animal sources, increases glomerular filtration workload and generates higher levels of nitrogenous waste, such as urea, which can accumulate in patients with reduced kidney function. High protein diets, especially from meat, can also increase intraglomerular pressure and accelerate kidney damage over time.

Plant-based proteins, such as beans, lentils, and nuts, are easier on the kidneys because they generate less acid, produce lower levels of uremic toxins, and contain phosphorus in a less bioavailable form than animal proteins, reducing the risk of hyperphosphatemia. Diets high in acid-producing foods can exacerbate metabolic acidosis, which is common in CKD and contributes to bone demineralization, progression of kidney damage, and increased muscle catabolism.

“I would divide people with kidney disease into two categories. One is those with CKD who have who whose kidneys are functioning adequately and they're not yet progressed to where they're on dialysis,” said Pflederer. “In that group of patients, it is very clear from the literature that a moderate protein diet is protective of the kidneys compared to a high protein diet, and then actually more importantly is that proteins that are plant based are better for the kidneys.”

Conversely, insufficient protein intake can lead to loss of lean body mass, sarcopenia, and impaired immune function, particularly in patients on dialysis who have higher protein requirements to compensate for amino acid losses during treatment. The optimal protein intake depends on individualized factors including CKD stage, dialysis status, body weight, and comorbid conditions, balancing the need to preserve muscle mass while minimizing renal stress.

Editor’s Note: Pflederer reports no relevant disclosures.

Fact Sheet: Trump Administration Resets U.S. Nutrition Policy, Puts Real Food Back at the Center of Health. HHS.gov. Published January 7, 2026. 

https://www.hhs.gov/press-room/fact-sheet-historic-reset-federal-nutrition-policy.html

American Kidney Fund. Kidney-friendly eating plan | American kidney fund. www.kidneyfund.org. Published December 1, 2021. 

https://www.kidneyfund.org/living-kidney-disease/healthy-eating-activity/kidney-friendly-eating-plan

National Kidney Foundation. Nutrition and Kidney Disease, Stages 1-5 (Not on Dialysis). National Kidney Foundation. Published 2024. 

https://www.kidney.org/kidney-topics/nutrition-and-kidney-disease-stages-1-5-not-dialysis

‌Healthy eating for adults with chronic kidney disease. National Institute of Diabetes and Digestive and Kidney Diseases. Published May 10, 2025. 

https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/healthy-eating-adults-chronic-kidney-disease

Ko GJ, Kalantar-Zadeh K. How important is dietary management in chronic kidney disease progression? A role for low protein diets. 

Videos

Updated federal guidelines highlight protein intake, with Tim Pflederer emphasizing the importance of individualized nutrition strategies for CKD patients


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The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine.

 in glomerular disease outcomes among patients aged 14–25 years, clinicians may need to implement more frequent follow-ups to help young adults balance competing priorities.

“Care should always be individualized, but this age group often requires additional nuance. A 20-year-old with glomerular disease can vary widely in independence and ability to manage a complex medical condition,” explained Andrew Vissing, MD, an attending physician and assistant professor at Northwestern University Feinberg School of Medicine, in an interview with 

. “Early in diagnosis, these diseases often require close follow-up, and adolescents and young adults are at higher risk of being lost to follow-up because of competing life priorities.”

Findings from the Cure Glomerulonephropathy (CureGN) consortium in patients with 

focal segmental glomerulosclerosis (FSGS)

 highlight unique disease trajectories in this age group, including higher relapse rates, faster kidney function decline, and, in some cases, quicker remission.

These differences suggest clinicians should not rely on arbitrary age cutoffs but instead view adolescents and young adults as a distinct group requiring tailored monitoring and treatment strategies.

In the United States, an estimated 0.4% of adolescents aged 12–17 have some form of 

, with glomerular diseases accounting for roughly 18% of pediatric kidney disease cases and affecting thousands. Previous CureGN research suggested that approximately 25% of individuals with adolescent-onset glomerular disease reached the composite eGFR decline outcome within five years, reflecting an increased risk of disease progression compared with both younger and older patients.

Globally, glomerular disease affects millions, and incidence has been increasing over the past decades, highlighting the growing need for age-specific care models.

Adolescence and young adulthood are transitional periods, particularly for patients managing glomerular disease. The focus on newfound independence, social pressures, and adjusting to careers can push disease management to the background. Additionally, this period also often coincides with transitions from pediatric to adult care providers, which can disrupt continuity and contribute to missed appointments or delayed treatment adjustments.

From Vissing’s perspective, many patients in this age group may not initially grasp the seriousness of their disease. To address this, he implements shorter follow-up windows and frequently involves nurses or social workers to facilitate laboratory testing, medication access, and appointment adherence.

This approach of increased support and monitoring benefits patients struggling to manage their own care. At the same time, Vissing notes he finds some young adults are capable of independently managing their kidney health, highlighting the need for flexible care strategies tailored to each patient’s level of independence.

Another challenge for this population is limited access to newer therapies and clinical trial participation due to age-based cutoffs, typically set at 18 years. While this was not the focus of the study, Vissing emphasized it as an important area for improving care.

“Pediatric patients < 18 are often excluded from trials of new medications, and it can take years for approved adult therapies to become available to younger patients,” he said. “While this was beyond the scope of our study, it highlights an important gap for adolescents and young adults, particularly those who fall just under age-based eligibility thresholds despite potentially benefiting from these treatments.”

Taken together, these findings underscore the need for clinicians to develop structured follow-up plans, consider multidisciplinary support, and advocate for trial inclusion to optimize outcomes for this age group.

Editor’s Note: Vissing reports no relevant disclosures.

Vissing A, Fishbein J, Smith AR, et al. Is Age Just a Number? Kidney360. Published online December 23, 2025. doi:

Garrity K, Putnam N, Kamil ES, et al. Comparing adolescent glomerular disease clinical outcomes to the clinical outcomes in childhood, young adult, and adult-onset glomerular disease in the CureGN database. Pediatric Nephrology. Published online December 27, 2024. doi:

https://doi.org/10.1007/s00467-024-06566-4

Sun P, Ming X, Song T, et al. Global burden of chronic kidney disease in adolescents and young adults, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Frontiers in Endocrinology. 2024;15. doi:

https://doi.org/10.3389/fendo.2024.1389342

World Health Organization. Coming of age: adolescent health. www.who.int. Published 2024. 

https://www.who.int/news-room/spotlight/coming-of-age-adolescent-health

Podcasts

Andrew Vissing shares his clinical perspective and strategies to mitigate gaps in care and management for young adults with glomerular disease.


IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Focal Segmental Glomerulosclerosis

The HCPLive focal segmental glomerulosclerosis page is a resource for medical news and expert insights on FSGS. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in FSGS, and more. 

podcasts page features a feed of medical news and interview podcast series, including DocTalk, Lungcast, Derm Discussions, and Heart Trials.

Implementing Age-Specific Care For Young Adults With Glomerular Disease With Andrew Vissing, MD

Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

The American College of Chest Physicians (CHEST) has released a new clinical guideline on biologic management in severe 

, including 7 evidence-based recommendations for pulmonologists, allergists, and immunologists to inform treatment decision making, many of which favor dupilumab for treatment.

“Severe asthma affects 5% to 10% of asthma patients but constitutes close to one-half of the medical costs related to asthma due to higher morbidity and health care utilization. Biologic agents have become a standard of care in those unresponsive to standard treatments, yet the choice of biologic agent is complex due to the varying mechanisms of action, efficacies, and lack of head-to-head comparisons. Therefore, clinicians need further clinical guidance to optimize their use,” lead author on the guideline, Amber J. Oberle, MD, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Duke University, Durham, North Carolina, and colleagues wrote.

Oberle and colleagues conducted a systematic literature review of randomized controlled trials (RCTs) and systematic reviews published in English in the MEDLINE, EMBASE, CINAHL, Web of Science, and CENTRAL databases through August 2024 to address 7 questions developed by an ACCP expert panel of 12 pulmonologists and allergists from 3 countries and created recommendations using The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach to assess the certainty of evidence and grading of the clinical recommendations.

“While there are studies available to help guide the clinician for initial biologic selection, to date, there is no published guideline to assist in biologic selection when a patient has tried and failed one or more biologics,” Amber J. Oberle, MD, lead author on the guideline, said in a statement.

 “In addition to following this guideline, decisions as to how to individualize biological therapy should occur under a shared decision-making process that carefully considers underlying asthma comorbidities, T2 biomarkers, injection frequency, mode of administration, and access to resources.”

Should adults with moderate to severe allergic asthma and a history of at least 1 exacerbation annually requiring oral corticosteroids (OCS) use dupilumab or omalizumab?

In adult patients with moderate to severe allergic asthma and a history of ≥ one exacerbation per year requiring oral corticosteroids, the panel conditionally recommends (very low certainty of evidence) either omalizumab or dupilumab; however, for patients with more frequent or severe exacerbations requiring hospitalization, the panel recommends dupilumab over omalizumab.

Should adults with steroid dependent asthma use anti-IL5/5Rα or dupilumab?

For adults with severe, steroid-dependent asthma, the panel conditionally recommends (very low certainty of evidence) anti–IL-5/5Rα therapy or dupilumab, with anti–IL-5/5Rα favored in patients with very high pre-OCS eosinophil counts. Dupilumab should be considered when comorbid atopic dermatitis or eosinophilic esophagitis are present, or either dupilumab or mepolizumab if CRSwNP is present.

Should adults with steroid dependent asthma use dupilumab or tezepelumab?

In OCS-dependent severe asthma, dupilumab is conditionally recommended over tezepelumab due to its demonstrated ability to reduce OCS dosing, despite both agents improving key asthma outcomes and lacking direct comparative trials.

Should adults with moderate to severe asthma not showing clinical response to omalizumab after 4 to 6 months switch to anti-IL5/5Rα therapy or dupilumab?

For adults with moderate to severe asthma who fail to respond to omalizumab after 4–6 months, the guideline suggests switching to anti–IL-5/5Rα therapy or dupilumab, with agent selection guided by biomarkers such as FENO, eosinophil counts, and comorbidities.

Should adults with severe asthma not showing clinical response to anti-IL5/5Rα therapy after 4 to 6 months switch to dupilumab or tezepelumab?

Among patients with severe asthma who do not respond to anti–IL-5/5Rα therapy, the panel conditionally recommends dupilumab or tezepelumab, favoring dupilumab in those who are OCS dependent or have OCS-related complications.

Should adults with severe asthma not showing clinical response to dupilumab after 4 to 6 months switch to anti-IL5/5Rα therapy or tezepelumab?

For adults with severe asthma who fail dupilumab after 4–6 months, anti–IL-5/5Rα therapy or tezepelumab is conditionally recommended, with anti–IL-5/5Rα favored in steroid-dependent patients and tezepelumab considered in those with low eosinophils or low FENO.

Should fractional exhaled nitric oxide (FENO) levels guide therapy changes to dupilumab in adults with severe asthma on anti-IL5/5Rα therapy not showing clinical response by 4 to 6 months?

The guideline suggests using a post-treatment FENO ≥25 ppb to help guide a switch to dupilumab in patients who fail anti–IL-5/5Rα therapy, while emphasizing that FENO should be interpreted alongside clinical factors and alternative options such as tezepelumab.

“Given that there are currently no comparative effectiveness studies, nor is there a validated, commonly agreed definition of clinical response, biologic therapies can only be individualized in daily practice using indirect comparisons of data (delineated into conditional recommendations),” Oberle and colleagues wrote in the guideline.

“Decisions as to how to individualize biologic therapy should occur under a shared decision-making process that carefully considers underlying asthma comorbidities, T2 biomarkers, injection frequency, mode of administration, and access to resources.”

Oberle AJ, Abbas F, Adrish M, et al. Biologic Management in Severe Asthma for Adults: An American College of Chest Physicians Clinical Practice Guideline. CHEST. Published online September 24, 2025. doi: 10.1016/j.chest.2025.08.042

CHEST releases guideline on biologic management in severe asthma. EurekAlert! Published January 13, 2026. Accessed January 20, 2026. https://www.eurekalert.org/news-releases/1112522

Articles

The American College of Chest Physicians has issued a new guideline on biologic management for severe asthma, providing seven evidence-based recommendations. These guidelines aim to assist pulmonologists, allergists, and immunologists in making informed treatment decisions, particularly favoring dupilumab in certain scenarios. The recommendations address various clinical situations, such as steroid-dependent asthma and non-responsiveness to initial biologic treatments. The guideline emphasizes the importance of shared decision-making, considering factors like asthma comorbidities, T2 biomarkers, and treatment accessibility, due to the absence of direct comparative studies and a standardized definition of clinical response.

New guidelines on biologic management for severe asthma provide essential recommendations for optimizing treatment choices among clinicians.

Asthma

The HCPLive asthma page is a comprehensive resource for clinical news and insights on asthmatic disease. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for allergic and severe asthma, and more.

Pulmonology

Infectious Disease condition center page is a comprehensive resource for clinical news and insights on respiratory health. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for asthma, COPD, interstitial lung disease, COVID-19, and more.

New CHEST Recommendations Guide Biologic Use for Severe Asthma

Improving Recognition of Skin Disease in Diverse Skin Types, With Shawn Kwatra, MD, and Andrew Alexis, MD, MPH

, Shawn Kwatra, MD, and Andrew Alexis, MD, MPH, discuss the unique challenges of diagnosing and managing 

 in patients with skin of color, with a particular focus on chronic pruritus and atopic dermatitis. Their conversation underscores how traditional dermatologic education and assessment tools often fail to capture the full spectrum of disease presentation across diverse skin tones.

Kwatra emphasizes that itch is one of the most common yet underappreciated symptoms affecting patients of color, particularly Black patients, who experience higher rates of chronic pruritus and related inflammatory conditions. He notes that despite this increased burden, these patients are frequently underdiagnosed or undertreated due to gaps in clinical recognition and limited representation in research. Alexis builds on this point by highlighting how erythema—an essential marker of inflammation—may not appear as classic redness in richly pigmented skin, instead presenting as violaceous, gray, or brown hues. This difference can lead clinicians to underestimate disease severity if they rely solely on traditional visual cues.

Both speakers stress the importance of adapting diagnostic frameworks to account for these variations. Alexis points out that clinicians must rely on a combination of texture, scale, patient-reported symptoms, and subtle color changes rather than erythema alone when evaluating inflammation in skin of color. Kwatra adds that emerging research is beginning to quantify these disparities, reinforcing the need for more inclusive clinical trials and better educational resources.

The discussion also touches on broader systemic issues, including environmental exposures, socioeconomic factors, and structural inequities that contribute to disease severity and access to care. Together, Kwatra and Alexis advocate for a more comprehensive, equity-driven approach to dermatology—one that recognizes how skin disease manifests differently across populations and prioritizes culturally informed, patient-centered care.

To learn more about SOCS’s programs and initiatives, visit 

Editor’s note: This summary was edited with the help of AI tools.

This segment of the most recent episode of Skin of Color Savvy highlights a conversation between Shawn Kwatra, MD, and Andrew Alexis, MD, MPH.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Seltorexant Limits Weight Gain in Obese MDD Patients, With Celine Goldberger, MD, PhD

Subgroup analyses from a 26-week, double-blind, head-to-head study suggest that the metabolic benefits associated with adjunctive seltorexant for 

 may be particularly pronounced in patients with obesity.

Celine Goldberger, MD, PhD, vice president of global medical affairs at Johnson & Johnson, discussed the findings with

 following the study’s presentation at the American College of Neuropsychopharmacology (ACNP) annual meeting from January 12 – 15, 2026, in the Bahamas.

“We see that there is less weight gain with seltorexant than quetiapine, and when you look at the obese population—the patients were obese at baseline—there was actually no change on average with seltorexant, [compared with an] increase in weight with quetiapine [of] about 1.9 kilograms,” Goldberger told 

The trial compared adjunctive seltorexant, an investigational orexin-2 receptor antagonist, with adjunctive quetiapine XR in adults with major depressive disorder (MDD) and clinically significant insomnia symptoms. While the primary endpoint assessed antidepressant response, showing numerically greater response rates and fewer discontinuations due to adverse events with seltorexant, the ACNP poster focused on longer-term metabolic outcomes, including body weight and insulin resistance.

In the interview, Goldberger emphasized that insomnia is highly prevalent in MDD, affecting roughly two-thirds of patients, and that a substantial proportion continue to experience residual insomnia despite treatment with SSRIs or SNRIs. Depression with comorbid insomnia is also associated with greater rates of obesity, diabetes, and other cardiovascular risk factors, underscoring the importance of considering metabolic effects when selecting adjunctive therapies.

Goldberger noted that weight gain remains a common reason for discontinuation of psychiatric medications, especially antipsychotics used adjunctively for their sedative properties. In this context, she suggested that having an adjunctive option with a more favorable tolerability profile could support longer-term treatment continuity and help patients remain engaged in care as they work toward remission. She said the next step is assessing seltorexant in real-world settings, as well as assessing its safety profile in further studies.

“[Seltorexant] will really help patients in their quest to achieve remission of their depressive episodes,” Goldberger said. “It’s really having an additional option in the moratorium…to be able to really offer a great efficacy…with a very nice probability profile and some benefits compared to what's available.”

Goldberger has no relevant reported disclosures.

Wajs E, Trombello JM, Kelly R, et al. Metabolic profiles of participants with major depressive disorder with insomnia symptoms in a phase 3 trial of seltorexant versus quetiapine extended release as adjunctive therapy. Poster presented at American College of Neuropsychopharmacology 64th Annual Meeting 64th annual meeting; January 12-15; Bahamas. Accessed January 19, 2026.

Goldberger C. Seltorexant Shows Favorable Metabolic Profile, With Celine Goldberger, MD, PhD. HCPLive. Accessed on January 19, 2026. Published on January 19, 2026. 

https://www.hcplive.com/view/seltorexant-shows-favorable-metabolic-profile-celine-goldberger-md-phd

In a 26-week study, adjunctive seltorexant showed no average weight gain in obese patients with MDD and insomnia unlike quetiapine, according to data presented at ACNP 2026.


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Obesity Management

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Seltorexant Limits Weight Gain in Obesity, MDD, With Celine Goldberger, MD, PhD

Michael Weintraub, MD, is an assistant professor of medicine in the division of endocrinology at NYU Langone Health.

Weintraub discusses how patients with overweight or obesity, regardless of T2D, will regain weight in varying degrees after discontinuing therapy.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

GLP-1 Discontinuation Results in Significant Weight Regain, With Michael Weintraub, MD

An audio recap of the top 5 stories in healthcare news from the week of 01/04-01/10.

Type 1 Diabetes

Schizophrenia

The HCPLive schizophrenia page is a resource for medical news and expert insights on the mental disorder. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for schizophrenia, and more.

Dementia and Alzheimer Disease

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HCPLive 5 Stories in Under 5: Week of 01/11

In a 26-week head-to-head study, adjunctive seltorexant led to less weight gain and improved insulin sensitivity trends compared with quetiapine XR in MDD with insomnia.


Sleep

On the HCPLive sleep page, resources on the topics of medical news and expert insight into sleep medicine can be found. Content includes articles, interviews, videos, podcasts, and breaking news on sleep apnea, insomnia, narcolepsy, and more.

Seltorexant Shows Favorable Metabolic Profile, With Celine Goldberger, MD, PhD

In the final episode, ‘Closing Thoughts on Hypoparathyroidism Management,’ the panelists share their key takeaways from the series discussion on hypoparathyroidism.

Video Series

Closing Thoughts on Hypoparathyroidism Management

In ‘Emerging Therapies in Hypoparathyroidism,’ our experts delve into three emerging therapies in chronic hypoparathyroidism.



Emerging Therapies in Hypoparathyroidism

In this episode, ‘Value of Medical Advocates for Patients and Educational Resources for Clinicians in Hypoparathyroidism,’ the experts explore the importance of recommending medical advocates or medical alerts to patients as well as educational resources that are available for community providers to better manage hypoparathyroidism.



Value of Medical Advocates for Patients and Educational Resources for Clinicians in Hypoparathyroidism

This episode, titled ‘Multidisciplinary Approaches to Hypoparathyroidism Management,’ features expert endocrinologists discussing the role of multidisciplinary collaboration among endocrinologists, nephrologists, and primary care providers.



Multidisciplinary Approaches to Hypoparathyroidism Management

In ‘Safety and Titration Considerations and Quality of Life Impact of PTH-Based Therapy in Hypoparathyroidism,’ our panel delves into the potential titration challenges, safety considerations, and long-term monitoring of PTH-based therapy in patients with hypoparathyroidism. They also discuss the impact of PTH-based therapy on patient quality of life.

Safety and Titration Considerations and Quality of Life Impact of PTH-Based Therapy in Hypoparathyroidism

In this episode, ‘Addressing Bone Health in the Management of Hypoparathyroidism,’ the experts explore approaches to managing hypoparathyroidism in patients with osteoporosis.

Addressing Bone Health in the Management of Hypoparathyroidism

This episode, titled ‘Evaluating the Efficacy and Safety of Palopegteriparatide in Hypoparathyroidism from the PaTHway Trial,’ features panelists discussing the efficacy and safety data of palopegteriparatide in hypoparathyroidism from the phase 3 PaTHway trial as well as the limitations of the trial.

Latest News

New Federal Dietary Guidelines Impact on Chronic Kidney Disease Management With Tim Pflederer, MD

Implementing Age-Specific Care For Young Adults With Glomerular Disease With Andrew Vissing, MD

New CHEST Recommendations Guide Biologic Use for Severe Asthma

Improving Recognition of Skin Disease in Diverse Skin Types, With Shawn Kwatra, MD, and Andrew Alexis, MD, MPH

Seltorexant Limits Weight Gain in Obesity, MDD, With Celine Goldberger, MD, PhD