NorthStar Prime / Open-Science Research Archive / 07_renalshield_clinical_nutrition_scoping_review

Precision Clinical Renal Nutrition & Medication Safety in Maintenance Hemodialysis: A Scoping Synthesis of KDOQI 2020, KDIGO 2024, Phosphorus Bioavailability, and Transplant CYP3A4 Guardrails

Authors: Andre White & NorthStar Collaborative Research Faculty • Date: 2026-10-21 • License: CC-BY-4.0 • Report ID: NSP-2026-07_RENALSHIELD_CLINICAL_NUTRITION_SCOPING_REVIEW
Epistemic Status: VERIFIED_CLINICAL_GUIDELINE_SYNTHESIS_HELD
Governance & Peer-Review Status: STRICT CLINICAL HOLD: Requires formal co-author review and approval by a licensed nephrologist / registered renal dietitian and Andrew before any external preprint deposit.
Clinical Hold — Full Manuscript Held for Licensed RD / Physician Co-Author Review BibTeX (.bib) EndNote / Zotero (.ris)

Structured Abstract

Synthesizing 53 clinical trials and nephrology practice guidelines (KDOQI 2020, ADA 2026 Section 11, KDIGO 2024, CONVINCE, PIVOTAL), this scoping review formalizes six computational and clinical guardrails for maintenance hemodialysis (CKD Stage 5D) nutrition informatics: (1) preserving 1.0-1.2 g/kg/day high-biological-value protein to prevent protein-energy wasting (PEW); (2) stratifying dietary phosphorus by gastrointestinal bioavailability (20%-40% plant phytate < 40%-60% animal organic < 90%-100% inorganic 'phos' additives; Sullivan et al., JAMA, 2009); (3) enforcing a strict 'Missing != Zero' database integrity rule for undeclared phosphorus in USDA Branded Foods; (4) accounting for culinary potassium-leaching heterogeneity (Martinez-Pineda et al., 2020; Batista et al., 2021) and prohibiting KCl salt substitutes; (5) CDC Listeria monocytogenes thermal food-safety thresholds (145°F fish / 165°F poultry); and (6) excluding cannabinoids (THC/CBD) from renal culinary programs due to non-dialyzability, >50% elevated THC AUC in CKD 4/5, and 3.1x-4.2x tacrolimus CYP3A4/P-gp interaction toxicity.

Keywords: hemodialysis, KDOQI 2020, KDIGO 2024, phosphorus bioavailability, potassium leaching, protein-energy wasting, tacrolimus CYP3A4, food safety

Target Open-Science Venues & Open Referee Questions

medRxiv / JMIR Preprints / OSF (STRICTLY GATED — Held for Nephrologist & Registered Dietitian Co-Author Sign-Off)
  1. Clinician / Registered Dietitian review of all KDOQI 2020 and KDIGO 2024 target ranges and individualized patient overrides.
  2. Audit software enforcement of the `Missing != Zero` phosphorus rule across USDA FoodData Central queries.

BibTeX Citation Record

@article{blankestijn2023convince,
  author  = {Blankestijn, Peter J. and Fischer, Katharina I. and Barth, Claudia and others},
  title   = {Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure (CONVINCE Trial)},
  journal = {New England Journal of Medicine},
  volume  = {389},
  number  = {8},
  pages   = {700--709},
  year    = {2023},
  doi     = {10.1056/NEJMoa2304820}
}
@article{macdougall2019pivotal,
  author  = {Macdougall, Iain C. and White, Claire and Anker, Stefan D. and others},
  title   = {Intravenous Iron in Patients Undergoing Maintenance Hemodialysis (PIVOTAL Trial)},
  journal = {New England Journal of Medicine},
  volume  = {380},
  number  = {5},
  pages   = {447--458},
  year    = {2019},
  doi     = {10.1056/NEJMoa1810742}
}
@article{kalantar2010phosphorus,
  author  = {Kalantar-Zadeh, Kamyar and Gutekunst, Laura and Mehrotra, Rajnish and others},
  title   = {Understanding Sources of Dietary Phosphorus in the Treatment of Patients with Chronic Kidney Disease},
  journal = {Clinical Journal of the American Society of Nephrology (CJASN)},
  volume  = {5},
  number  = {3},
  pages   = {519--530},
  year    = {2010},
  doi     = {10.2215/CJN.06080809}
}