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

Tim Pflederer, MD

Guiding CKD Care Through Updated Dietary Guidelines, With Tim Pflederer, MD

In response to the recently released federal Dietary Guidelines for Americans, 2025–2030, nephrologists should ensure patients with impaired kidney function, 

) are following individualized, treatment-informed diets.

The US Department of Health & Human Services (HHS) released the updated guidelines on January 7, 2026, emphasizing high-quality protein, healthy fats, fruits, vegetables, and whole grains while discouraging highly processed foods and refined carbohydrates.

“I think the direction of [the guidelines] is right and good for kidney disease, but at the same time, there are nuanced messages that our patients need to hear related to those guidelines,” Tim Pflederer, MD, shared in an interview with 

Patients with renal impairment have reduced glomerular filtration rate (GFR), which limits the kidney’s ability to excrete potassium, phosphorus, and nitrogenous waste from protein metabolism. 

Excess protein, particularly from animal sources

, can increase renal solute load, stimulate hyperfiltration in residual nephrons, and accelerate CKD progression, as Pflederer highlighted in a previous discussion with our team.

Consequently, intake of high-potassium foods and protein must be carefully managed, with attention to laboratory monitoring, CKD stage, and dialysis schedules.

While the guidelines encourage more whole vegetables and fruits, clinicians should encourage their patients with kidney disease to carefully select options. Many common fruits and vegetables are high in potassium, Pflederer explained, including bananas, oranges, potatoes, tomatoes, avocados, and dried fruits.

Hyperkalemia occurs when serum potassium rises above safe physiologic levels, which can trigger cardiac arrhythmias and sudden death. In patients with advanced CKD or ESKD, impaired renal excretion makes them particularly vulnerable. Patients on dialysis rely on the treatment to remove extra potassium, so dietary intake must be carefully adjusted based on the timing of treatments between sessions.

“If they're having difficulty with potassium, they should talk to their physician to make certain that the foods that they're eating that are whole, fresh fruits and vegetables, particularly, are not high in potassium,” said Pflederer.

Clinicians can offer options with regulated levels of potassium, including apples, berries, grapes, white rice, white bread, and fresh white meat. Additionally, cooking methods such as boiling or leaching may reduce potassium content, which may help patients manage intake more safely.

The guidelines also encourage avoidance of processed foods, which Pflederer acknowledges can benefit kidney health. Many processed products contain phosphorus additives, which are almost completely absorbed and can accumulate quickly in patients with reduced kidney function, increasing the risk of mineral imbalances and long-term complications.

In patients with CKD, impaired kidney function reduces phosphate excretion, which can trigger increases in fibroblast growth factor 23 (FGF23) and parathyroid hormone (PTH). Over time, this can weaken bones and cause calcium to deposit in blood vessels and organs, increasing the risk of heart attack, stroke, and other complications.

“Eliminating processed foods will at the same time be overall good for their health, and eliminate and reduce the phosphorus burden that is difficult for people with kidney disease to handle,” said Pflederer.

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

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

‌Potassium and Chronic Kidney Disease - DaVita | DaVita. DaVita. Published June 20, 2025. 

https://davita.com/diet-nutrition/articles/potassium-and-chronic-kidney-disease/

Six Steps to Controlling High Potassium. National Kidney Foundation. Published August 12, 2024. 

https://www.kidney.org/news-stories/six-steps-to-controlling-high-potassium‌

‌National Kidney Foundation. Phosphorus and Your CKD Diet. National Kidney Foundation. Published June 26, 2025. 

https://www.kidney.org/kidney-topics/phosphorus-and-your-ckd-diet

Russo D, Battaglia Y. Clinical Significance of FGF-23 in Patients with CKD. 

Videos

Tim Pflederer, explains how nephrologists can help patients with CKD and ESKD navigate the 2025–2030 Dietary Guidelines, including managing protein, potassium, and phosphorus intake.

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 US 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 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, 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.

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

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


Tim Pflederer, MD

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