Dietary management of patients with type 2 diabetes and chronic kidney disease: A comprehensive literature review

Table 2 Summary of micronutrient recommendations

Nutrient	Key recommendations	Evidence and considerations
Potassium	Individualized restriction; prioritize natural sources (fruits/vegetables) over additives; limit processed foods with KCl	T2DM + CKD increases hyperkalemia risk (RAAS inhibitors, age); stepwise approach: Address non-dietary causes first, then limit low-nutrient sources (e.g., juices, chips); potassium additives in low sodium foods are highly bioavailable (↑ risk)
Phosphorus	Non-dialysis CKD: About 700 mg/day; hemodialysis: Monitor protein-bound phosphorus (1.2–1.4 g/kg/day ≈ 1450–1600 mg phosphorus)	Hyperphosphatemia drives vascular calcification; animal proteins and additives are major sources; however, strict restrictions risk malnutrition; education improves adherence in hemodialysis (limited evidence in other CKD stages)
Sodium	< 2 g/day (5 g salt); combine with DASH diet for BP control	High intake worsens HTN, CVD, and proteinuria; enhances RAAS-blocker efficacy but may transiently ↓eGFR (protective hyperfiltration reduction?); DASH diet + low sodium may slow CKD progression

BP: Blood pressure; CKD: Chronic kidney disease; CVD: Cardiovascular disease; DASH: Dietary Approach to Stop Hypertension; eGFR: Estimated glomerular filtration rate; HTN: Hypertension; KCl: Potassium chloride; RAAS: Renin-angiotensin-aldosterone system; T2DM: Type 2 diabetes mellitus.