From the Guidelines
Increased protein intake should be avoided in individuals with stages 3-5 non-dialysis-dependent chronic kidney disease (CKD), as it has been associated with increased albuminuria, more rapid kidney function loss, and cardiovascular disease (CVD) mortality 1. When considering the impact of protein intake on glomerular filtration rate (GFR), it is essential to prioritize the individual's kidney health and overall well-being. The current evidence suggests that high protein intake (>20% of daily calories from protein or >1.3 g/kg/day) can have detrimental effects on kidney function, particularly in those with pre-existing kidney disease.
Some key points to consider include:
- The recommended daily protein intake for individuals with stages 3-5 non-dialysis-dependent CKD is 0.8 g/kg body weight per day, which has been shown to slow GFR decline compared to higher protein intake levels 1.
- Reducing protein intake below the recommended daily allowance of 0.8 g/kg/day is not recommended, as it does not provide additional benefits for blood glucose levels, cardiovascular risk measures, or GFR decline 1.
- Certain organizations, such as the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF KDOQI) and the International Society of Renal Nutrition and Metabolism, recommend a lower protein intake level (0.6-0.8 g/kg/day) for reno-protection, although the evidence for this is primarily based on studies in individuals without diabetes 1.
In terms of managing blood pressure and reducing cardiovascular risk, restriction of dietary sodium (to <2,300 mg/day) and individualization of dietary potassium may be useful, particularly for individuals with reduced estimated GFR (eGFR) 1. However, these recommendations should be tailored to the individual's specific needs and comorbid conditions.
Overall, the evidence suggests that a moderate protein intake of 0.8 g/kg body weight per day is the most appropriate recommendation for individuals with stages 3-5 non-dialysis-dependent CKD, as it balances the need to support overall health while minimizing the risk of kidney damage and CVD mortality 1.