March 2026

Primary care providers (PCPs) can dramatically influence chronic kidney disease (CKD) trajectories by addressing more than medications: lifestyle optimization, nutrition, BP control, cardiovascular risk reduction, and electrolyte management. 

Diet is one of the most powerful tools available to slow CKD progression, reduce complications, and improve long‑term outcomes. PCPs are uniquely positioned to initiate and reinforce dietary strategies early, sometimes before a patient ever sees a nephrologist. Current guideline updates emphasize individualized nutrition therapy, plant‑forward eating patterns, and targeted restriction of key electrolytes and nutrients.

Why Diet Matters in CKD

A healthy diet can reduce all‑cause and cardiovascular mortality in CKD, particularly those emphasizing higher intake of fruits and vegetables and whole‑food patterns such as DASH‑like diets. Dietary patterns rich in fruits and vegetables are associated with lower mortality and slower CKD progression.

Nutrition directly influences CKD‑related risks such as hypertension, metabolic acidosis, electrolyte abnormalities, and progression to kidney failure.

Core Dietary Components for CKD Management

Sodium Reduction

Excess sodium contributes to hypertension and volume overload—key drivers of CKD progression. Limiting sodium is a foundational dietary intervention.
Patients should aim for minimizing added salt, avoiding processed foods, and cooking with whole ingredients when possible.

Protein Regulation

The updated KDIGO guidelines recommend a daily protein intake of 0.8 g/kg for adults with CKD stages 3–5 and advise against high protein intake (> 1.3 g/kg/day) for those at risk of progression. Very low–protein diets (0.3–0.4 g/kg/day) with essential amino acid or ketoacid supplementation may be appropriate under specialist supervision.
Favoring plant‑based protein sources may offer additional metabolic benefits.

Potassium Management

Management goal depends on hyperkalemia risk. Patients prone to high potassium levels should limit high‑potassium foods (>200 mg/serving) and choose lower‑potassium alternatives when appropriate.
Lifestyle modification recommendations also include reviewing modifiable contributors and considering medications such as potassium binders rather than reflexively discontinuing RAAS inhibitors when hyperkalemia occurs.

Phosphorus Restriction

Phosphorus accumulation increases risk for bone disease and cardiovascular calcification. Patients should limit phosphorus‑rich foods and avoid phosphorus additives, which offer no nutritional value and are universally detrimental for CKD.

Processed foods often contain hidden phosphorus additives, making label reading essential.

Calcium Recommendations

Traditionally, the National Kidney Foundation (KDOQI) recommended limiting total calcium intake to ≤2000 mg/day (diet + supplements + binders). Updated European consensus recommendations suggest 800–1000 mg/day total intake, not exceeding 1500 mg/day, to maintain neutral balance without promoting calcification. This reflects a newer understanding: both too little and too much calcium are harmful.

Fluid Considerations

Fluid needs vary. As CKD advances, some patients may require fluid restriction to avoid volume overload. Monitoring is individualized and guided by clinical assessment.

Emphasize Whole‑Food, Plant-Forward Eating

KDIGO 2024 guidelines highlight the benefits of diets rich in plant-based foods and low in ultra‑processed foods. Practice Point 3.3.1 encourages prioritizing plant-based foods to reduce intake of animal and processed products.

The Role of Registered Dietitians

Both KDIGO and KDOQI strongly recommend referral to renal dietitians for personalized nutrition counseling. Adjustments to sodium, potassium, phosphorus, protein, and fluids require individualized strategies tied to disease stage, comorbid conditions, and patient preferences.

A Primary Care Action Plan

• Initiate early dietary counseling at CKD diagnosis.
• Provide simple targets: reduce sodium, moderate protein, choose whole foods, and avoid additives.
• Review labs regularly to guide potassium and phosphorus adjustment.
• Reinforce that diet is a core disease‑modifying therapy—not an optional add‑on.
• Refer to a renal dietitian whenever possible.

For further information, please visit: CKD Evaluation and Management – KDIGO

Successful colonoscopy depends heavily on high‑quality bowel preparation—but for many patients, the process feels confusing, unpleasant, or overwhelming. Bowel prep is one of the top patient concerns related to obtaining colonoscopies, along with logistical barriers (insurance, transportation, accompaniment), fear of the procedure, and low awareness of individual risk for colon cancer.

Primary care providers play a pivotal role in setting expectations early and helping patients navigate the prep with confidence. Small adjustments in counseling can significantly improve prep quality, reduce the need for repeat procedures, and increase screening adherence.

Set the Stage Early

Prep instructions often arrive from gastroenterology, but the conversation should begin in primary care. A simple statement during the referral —“The prep is the hardest part, but we’ll make it manageable” — helps reduce anxiety. Clarify that preparation quality directly affects cancer detection and determines whether the test must be repeated.

Use Clear, Patient‑Friendly Prep Instructions

Confusion is one of the most common drivers of inadequate prep. Encourage patients to:

• Follow written instructions step‑by‑step and keep them visible on the fridge.
• Understand the timing: when to switch to clear liquids, when to start drinking the prep, and what “split dosing” means.
• Know which medications to hold or adjust, especially anticoagulants, diabetes medications, diuretics, and iron supplements.

When possible, choose instructions written at a 6th‑grade reading level with visuals or checklists. Keep the instructions to one page to ensure easier understanding for people with low health literacy.

Address Common Barriers Ahead of Time

Ask patients about:

• Work schedules: They may need a day off before the procedure to complete prep without rushing.
• Transportation: Some avoid colonoscopy because they lack a ride.
• Constipation history: Patients with chronic constipation, opioids, or slow motility may need a 2–3 day low‑fiber diet or a pre‑prep laxative plan.

A few extra minutes uncover obstacles that can easily be solved early.

Normalize the Experience

Patients often feel embarrassed or worried about the intensity of the prep. Normalizing expectations—“Everyone spends a lot of time in the bathroom; that means it’s working”—decreases anxiety. Remind them that the stool should become clear or pale yellow near the end.

Emphasize Split‑Dose Prep

Split-dose regimens — taking half the night before, half the morning of the procedure — consistently produce superior cleansing and improve polyp detection. Many patients assume they must drink everything the night before; a brief reassurance that morning dosing is both safe and preferred can dramatically improve adherence.

Make the Prep More Palatable

Providers can offer simple, evidence‑based tips to improve tolerance:

• Chill the prep solution and drink it through a straw.
• Add lemon, ginger, or flavor packets if allowed by the GI team.
• Drink a glass of clear liquid between doses to reduce nausea and bloating.
• Slow down briefly—not stop—if cramps or queasiness occur.

Some patients may qualify for low‑volume preps, which can be more acceptable than traditional large-volume PEG solutions.

Offer Low-Volume Bowel Prep Options

Many patients avoid or poorly complete colonoscopy prep because of the large volumes required with traditional PEG solutions. Low‑volume preparations — typically 1 to 2 liters compared with older 4‑liter regimens — can substantially improve comfort, adherence, and overall cleansing quality. Evidence indicates that patients strongly prefer low‑volume options, and these regimens are often as effective as high‑volume solutions when used with proper instructions.

• Low‑volume solutions are preferred by patients while maintaining comparable efficacy to high‑volume options.
  • These are ideal for: people who have previously struggled with high volume prep, have baseline nausea, are likely to experience volume overload symptoms, or have expressed fear or hesitation about “drinking that much liquid.”
• Patient-reported surveys show that the amount of liquid required is highly important to most adults undergoing colonoscopy — 84% consider it “important or somewhat important.”
• For patients with prior intolerance, nausea, or anxiety around prep, emphasize that modern low‑volume preps are typically easier to tolerate and may drastically reduce the amount they need to drink.

Reinforce the Value

The prep may be uncomfortable, but the payoff is tremendous: colorectal cancer is highly preventable, and a clean colon allows gastroenterologists to find and remove polyps in a single visit. Framing prep as an investment in long‑term health keeps patients motivated.

Conclusion

“Prep hesitancy” remains a meaningful obstacle to obtaining colonoscopies, and patient surveys highlight that the volume and palatability of prep solutions significantly influence willingness to undergo the procedure. Offering clearer counseling, simplifying instructions, and utilizing low‑volume prep options can directly address these concerns and improve both patient experience and screening rates.

Although it’s not even spring, it’s never too early for practices to complete their annual required training. Independent Health requires each of its participating provider groups or practices to complete Fraud, Waste & Abuse Training and submit an electronic attestation to confirm completion of this training by each of their staff members. 

Staff members of practices required to complete this training includes physicians, advanced practice providers, ancillary providers, registered nurses, licensed practical nurses, administrative and office staff, technicians, coders and others.
 
The downloadable training module for your staff, and an attestation to verify with Independent Health that this training has been completed are available online.
 
Who must submit each attestation?
 
An authorized representative should submit the attestation on behalf of all individuals under a practice’s Tax Identification Number (TIN). Individual staff members do not need to submit their own individual attestations.
 
If your practice has already completed this 2026 training through another source and has a roster or spreadsheet with the dates the training was completed, you may submit the attestation through each of Independent Health’s public provider portal pages above.

Cultural Competency coming later in 2026

The specific training module required by New York State is being updated by the federal Department of Health and Human Services. We will notify providers when it is available. 

 
Questions?
If you have questions, please call Independent Health Provider Relations at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 5 p.m.

Independent Health develops outreach campaigns to members in need of certain preventive services and to help make them aware of our programs and resources to help them maintain or improve their health. Here is a summary of the current outreach campaigns underway. 

It is important to verify the patient’s plan before referring the patient to another provider in order to avoid billing denials and patient coverage issues.  

Remember to view our up-to-date policies online.