{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T23:45:56Z","timestamp":1790034356578,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Adherence to Medical Nutrition Therapy (MNT) is a key determinant of therapy success, particularly in chronic diseases like chronic kidney disease (CKD). MNT in CKD requires significant changes in patient\u2019s dietary habits, which can affect long-term adherence. This study aims to evaluate the adherence to MNT in stage 5 CKD patients undergoing conservative kidney management (CKM), identifying potential challenges and strengths of nutritional intervention. Methods: We enrolled in 94 stage 5 CKD patients undergoing CKM at the University Hospital of Modena, Italy. We collect clinical data from medical and nutrition records. The inclusion criteria comprised patients of all genders, ages, and ethnicity with stage 5 chronic kidney disease (CKD), in pre-dialysis, enrolled in the nephrology and dietetics program, who had access to 24-h urine tests, anthropometric measurements, and dietary history records. Exclusion criteria included patients with CKD stages lower than 5, those who had not undergone at least one nutritional assessment, or lacked accessible 24-h urine data. The study utilized medical and dietary records from September 2017 to March 2025. The primary outcome was the assessment of adherence to medical nutrition therapy (MNT), comparing prescribed protein intake with actual intake, estimated from dietary history (DH). Protein intake was compared with normalized protein nitrogen appearance (nPNA) as stated by recent guidelines. Additional factors influencing adherence, such as age, gender, comorbidities, physical activity, and prior dietary interventions, were also evaluated. Anthropometric measurements and biochemical tests were collected, and dietary intake was assessed using a seven-day DH. Results: Data were analyzed using descriptive statistics, linear correlation models, univariate logistic regression, t-tests, paired t-tests, and chi-square tests, with significance set at p &lt; 0.05. Most of the patients follow suggested energy and protein intakes limits; however, substantial individual variability emerged Bland\u2013Altman analysis indicated a moderate bias and wide limits of agreement for energy intake (+116 kcal; limits of agreement \u2013518.8 to +751.3 kcal), revealing frequent overestimation in self-reports. Protein intake showed less systematic error, but discrepancies between dietary recall and biochemical markers persisted. Protein intake decreased significantly over time (p &lt; 0.001), while correlation with nPNA did not reach statistical significance (\u03c1 = 0.224, p = 0.051). No significant associations were identified between adherence and most clinical or lifestyle factors, although diabetes was significantly associated with lower adherence to protein intake (p = 0.042) and a predominantly sedentary lifestyle showed a borderline association with energy intake adherence (p = 0.076), warranting further investigation. Longitudinal analysis found stable BMI and body weight, alongside notable reductions in sodium (p = 0.018), potassium (p = 0.045), and phosphorus intake (p &lt; 0.001) over time. Conclusions: Assessing dietary adherence in CKD remains complex due to inconsistencies between self-reported and biochemical estimates. These findings highlight the need for more objective dietary assessment tools and ongoing, tailored nutritional support. Multifaceted interventions\u2014combining education, personalized planning, regular monitoring, and promotion of physical activity\u2014are recommended to enhance adherence and improve clinical outcomes in this vulnerable population.<\/jats:p>","DOI":"10.3390\/nu17193091","type":"journal-article","created":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T11:40:52Z","timestamp":1759146052000},"page":"3091","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Medical Nutrition Therapy Adherence and Lifestyle in Stage 5 CKD: Challenges and Insights"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5058-2350","authenticated-orcid":false,"given":"Patrizia","family":"Palumbo","sequence":"first","affiliation":[{"name":"Division of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0591-8622","authenticated-orcid":false,"given":"Gaetano","family":"Alfano","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Cavani","sequence":"additional","affiliation":[{"name":"Division of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Giannini","sequence":"additional","affiliation":[{"name":"Division of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto Angelo","family":"Pulizzi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Gabriele","sequence":"additional","affiliation":[{"name":"Division of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-0753-3326","authenticated-orcid":false,"given":"Niccol\u00f2","family":"Morisi","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy"},{"name":"Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floriana","family":"Cannito","sequence":"additional","affiliation":[{"name":"Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Menozzi","sequence":"additional","affiliation":[{"name":"Division of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero Universitaria di Modena, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8549-1221","authenticated-orcid":false,"given":"Gabriele","family":"Donati","sequence":"additional","affiliation":[{"name":"Nephrology, Dialysis and Kidney Transplant Unit, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy"},{"name":"Surgical, Medical, Dental and Morphological Sciences Department (CHIMOMO), University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S117","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease","volume":"105","author":"Stevens","year":"2024","journal-title":"Kidney Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1093\/ndt\/gfz147","article-title":"Dietary Satisfaction and Quality of Life in Chronic Kidney Disease Patients on Low-Protein Diets: A Multicentre Study with Long-Term Outcome Data (TOrino-Pisa Study)","volume":"35","author":"Piccoli","year":"2020","journal-title":"Nephrol. 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