What is the safe amount of protein intake for patients with grade 2 and grade 3 Chronic Kidney Disease (CKD)?

From the Guidelines

For patients with grade 2 and grade 3 Chronic Kidney Disease (CKD), the recommended protein intake is approximately 0.8 grams of protein per kilogram of body weight per day. This recommendation is based on the most recent and highest quality study available, which suggests that this level of protein intake can help slow the decline in kidney function while minimizing the risk of protein-energy wasting 1. It's essential to note that protein quality also plays a crucial role, with an emphasis on plant-based proteins and high-quality animal proteins, while limiting processed meats. Excessive protein intake should be avoided as it can increase the workload on the kidneys, potentially accelerating disease progression.

The kidneys filter waste products from protein metabolism, and with reduced kidney function in CKD, these waste products can accumulate. Regular monitoring of kidney function through blood tests (eGFR and creatinine) and urine protein levels is important to assess if protein recommendations need adjustment as the disease progresses. Patients should work with a nephrologist and renal dietitian to personalize their protein intake based on their specific kidney function, overall nutritional status, and other health conditions. Some studies suggest that lower protein intake levels, such as 0.6-0.8 g/kg/day, may be beneficial for reno-protection, but the evidence for this is primarily based on patients without diabetes 1. However, the most recent guideline recommends aiming for a target level of 0.8 g/kg body weight per day for people with non–dialysis-dependent stage 3 or higher CKD 1.

Key considerations for protein intake in CKD patients include:

• Avoiding excessive protein intake (>1.3 g/kg/day) to minimize the risk of accelerated kidney function loss and cardiovascular disease mortality
• Emphasizing high-quality protein sources, such as plant-based proteins and lean animal proteins
• Limiting processed meats and other low-quality protein sources
• Regularly monitoring kidney function and adjusting protein recommendations as needed
• Working with a healthcare team, including a nephrologist and renal dietitian, to develop a personalized nutrition plan.

From the Research

Safe Protein Intake for Grade 2 and Grade 3 CKD

The safe amount of protein intake for patients with grade 2 and grade 3 Chronic Kidney Disease (CKD) is a crucial aspect of their dietary management. According to the available evidence:

• A dietary protein intake of 0.8 g/kg body weight/day is recommended by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines 2.
• The Kidney Disease Outcome Quality Initiative (KDOQI) guidelines suggest a protein intake of 0.6-0.8 g/kg body weight/day for patients with CKD stages 3-5 2.
• Loosening protein restriction may be considered in CKD patients with sarcopenia, but it is safe to avoid protein intake of more than 1.5 g/kgBW/day 3.
• In CKD patients with high risk of end-stage kidney disease, a protein intake of 0.8 g/kgBW/day may be a critical point 3.
• A low-protein diet (LPD) of 0.6-0.8 g/kg/day is often recommended for the management of CKD, as high-protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration 4.

Key Considerations

• Protein restriction should be individualized, considering patient characteristics, such as socio-cultural norms, habitual dietary habits, and nutrition literacy 2.
• The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia 3.
• Controlled protein intake is one of the cornerstones of treatment in CKD patients, and a low protein intake in patients with CKD stages 3 and 4-5 was associated with loss of muscle mass 5.
• Adherence to a low-protein diet and adequate protein and energy intake should be ensured to avoid protein-energy wasting 4.

Protein Intake Recommendations

• For CKD patients with grade 2 and grade 3, a protein intake of 0.6-0.8 g/kg body weight/day is recommended 2, 4.
• For CKD patients with sarcopenia, loosening protein restriction may be considered, but it is safe to avoid protein intake of more than 1.5 g/kgBW/day 3.
• For CKD patients with high risk of end-stage kidney disease, a protein intake of 0.8 g/kgBW/day may be a critical point 3.