From the Guidelines
Dietary protein intake should be limited to 0.8 g/kg body weight per day for individuals with stages 3-5 non-dialysis-dependent chronic kidney disease (CKD) to slow GFR decline. This recommendation is based on the most recent evidence from the 2025 standards of care in diabetes, which suggests that higher levels of dietary protein intake (>20% of daily calories from protein or >1.3 g/kg/day) are associated with increased albuminuria, more rapid kidney function loss, and cardiovascular disease (CVD) mortality 1.
Key Considerations
- Reducing 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.
- Some organizations recommend a lower protein intake (0.6-0.8 g/kg/day) for reno-protection, but the evidence for this is primarily based on studies of individuals without diabetes 1.
- Low-protein eating patterns should only be followed under the guidance of a healthcare professional experienced in managing nutrition for individuals with CKD 1.
Implications for Clinical Practice
- Restricting dietary sodium (to <2,300 mg/day) and individualizing dietary potassium intake may be useful for managing blood pressure and reducing cardiovascular risk, particularly for individuals with reduced eGFR 1.
- For individuals on dialysis, higher levels of dietary protein intake should be considered to prevent protein-energy wasting 1.
- Regular kidney function monitoring is advisable for individuals with CKD who are consistently consuming high protein diets 1.
From the Research
Relationship Between Dietary Protein Intake and Glomerular Filtration Rate (GFR)
- The relationship between dietary protein intake and GFR is complex, with evidence suggesting that high-protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, potentially causing damage to glomerular structure and aggravating chronic kidney disease (CKD) 2.
- A low-protein diet (LPD) of 0.6-0.8 g/kg/day is often recommended for the management of CKD, as it may help to retard the progression of CKD and delay the initiation of maintenance dialysis therapy 2.
- However, the impact of dietary protein intake on GFR may vary depending on the individual's age, kidney function, and overall health status, with some studies suggesting that high-protein intake may be beneficial for older adults with mild to moderate CKD 3.
- A study found that in participants with impaired kidney function, a high dietary protein intake of ≥1.4 g/kg ABW/day was associated with higher mortality, while in participants with normal kidney function, a low dietary protein intake of <0.6 g/kg ABW/day was associated with higher mortality 4.
- Another study suggested that a plant-dominant low-protein diet of 0.6-0.8 g/kg/day with more than 50% from plant sources or very low protein diets less than 0.45 g/kg/day supplemented with essential amino acids or their keto-analogues may be effective in preserving kidney function in older patients and their younger counterparts 5.
Key Findings
- High-protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, potentially causing damage to glomerular structure and aggravating CKD 2.
- LPD may help to retard the progression of CKD and delay the initiation of maintenance dialysis therapy 2.
- The impact of dietary protein intake on GFR may vary depending on the individual's age, kidney function, and overall health status 3, 4, 5.
- A balanced and individualized dietary approach based on LPD should be elaborated with periodic dietitian counseling and surveillance to optimize management of CKD, to assure adequate protein and energy intake, and to avoid or correct protein-energy wasting 2.