What is the recommended protein intake for a patient with stage 4 chronic kidney disease (CKD) and an estimated glomerular filtration rate (eGFR) of 29?

From the Guidelines

For a patient with stage 4 chronic kidney disease (CKD) and an eGFR of 29, the recommended protein intake is 0.8 g/kg body weight per day, as this level has been shown to slow GFR decline with evidence of a greater effect over time, according to the most recent and highest quality study 1. This recommendation is based on the latest guidelines, which suggest that higher levels of dietary protein intake (>20% of daily calories from protein or >1.3 g/kg/day) should be avoided as they have been associated with increased albuminuria, more rapid kidney function loss, and CVD mortality 1. The following key points should be considered:

• The recommended daily protein intake of 0.8 g/kg body weight per day is applicable for adults with CKD G3–G5, as suggested by the KDIGO 2024 clinical practice guideline 1.
• Reducing the amount of dietary protein below the recommended daily allowance of 0.8 g/kg/day is not recommended, as it does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline 1.
• Regular monitoring of nutritional status, including serum albumin levels and body weight, is essential to ensure that the patient's protein intake is adequate and to prevent malnutrition and muscle wasting.
• The recommendation should be individualized based on the patient's overall health status, presence of comorbidities, and nutritional needs, ideally under the guidance of a renal dietitian and nephrologist.

From the Research

Protein Intake Recommendations for CKD Patients

The recommended protein intake for a patient with stage 4 chronic kidney disease (CKD) and an estimated glomerular filtration rate (eGFR) of 29 can be determined based on the following guidelines:

• A low-protein diet with a protein intake of 0.8-0.3 g/kg of body weight per day is recommended for CKD patients, as it can help slow the progression of the disease and reduce the risk of complications 2.
• For CKD patients with a high risk of end-stage kidney disease (ESKD), a protein intake of 0.8 g/kgBW/day may be a critical point, while for those with a low risk, a protein intake of up to 1.5 g/kgBW/day may be safe 3.
• The Kidney Disease Outcome Quality Initiative (KDOQI) guidelines recommend a protein intake of 0.8 g/kg BW/day for CKD patients, while the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend avoiding a protein intake of >1.3 g/kg BW/day 4.

Considerations for Protein Intake

When determining the recommended protein intake for a CKD patient, the following factors should be considered:

• The patient's individual characteristics, such as socio-cultural norms, habitual dietary habits, and nutrition literacy 4.
• The patient's nutritional status and the potential risks of protein restriction, such as malnutrition and sarcopenia 3, 5.
• The patient's kidney function and the progression of the disease, as well as the potential benefits of protein restriction in slowing the progression of CKD 2, 5.

Safe Protein Intake Range

Based on the available evidence, a safe protein intake range for CKD patients with an eGFR of 29 may be:

• 0.6-0.8 g/kg body weight per day, as recommended by the KDOQI and KDIGO guidelines 2, 4.
• Up to 1.5 g/kgBW/day for patients with a low risk of ESKD, as suggested by the study by 3.