What is the recommended protein intake for a 70-year-old male, weighing 172 pounds, 6 feet tall, with Chronic Kidney Disease (CKD) stage 4 and Impaired Renal Function?

From the Guidelines

For a 70-year-old male weighing 172 lbs (78 kg) with stage 4 chronic kidney disease (CKD), the recommended protein intake is approximately 0.8 grams of protein per kilogram of body weight daily, which translates to about 62 grams of protein per day, as recommended by the World Health Organization for the general population 1. This recommendation is based on the most recent and highest quality study, which suggests that restricting dietary protein intake to lower levels does not improve kidney or other clinical outcomes 1. The patient should focus on high-quality protein sources like egg whites, fish, and lean poultry while limiting red meat and processed proteins. It's essential to work with a renal dietitian to create a personalized meal plan that balances protein needs with other dietary restrictions such as potassium, phosphorus, and sodium limitations. Some key points to consider when creating a meal plan include:

• Maintaining adequate caloric intake from carbohydrates and healthy fats to prevent malnutrition and muscle wasting, which are common complications in advanced CKD
• Limiting sodium intake to less than 2 g/d to control blood pressure and reduce cardiovascular risk 1
• Regular monitoring of blood urea nitrogen (BUN), creatinine levels, and estimated glomerular filtration rate (eGFR) to adjust protein intake as kidney function changes. However, it's worth noting that more recent guidelines suggest that hospitalized patients with CKD without acute/critical illness may require a protein intake of 0.6-0.8 g/kg BW/d 1, but this may not be directly applicable to non-hospitalized patients. Overall, the key is to find a balance between providing adequate protein for overall health while minimizing the strain on the kidneys.

From the Research

Protein Intake Recommendations

• For a 70-year-old male, 172 lbs, 6' tall, with CKD stage 4, the recommended protein intake is 0.6-0.8 g/kg/day 2.
• This recommendation is based on the idea that high-protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which can cause damage to glomerular structure and worsen CKD 2.
• However, it's also important to ensure adequate protein and energy intake to avoid protein-energy wasting, which is a common complication in CKD patients 2, 3.

Considerations for CKD Stage 4

• CKD stage 4 patients have a higher risk of malnutrition and protein-energy wasting due to inadequate dietary intake and altered kidney metabolism 4.
• A low-protein diet (LPD) with 0.6-0.8 g/kg/day may be beneficial in slowing down CKD progression, but it's essential to ensure adequate calorie intake to prevent malnutrition 3, 2.
• The study by 3 found that CKD stage 3-5 patients with LPD had significantly lower hemoglobin and albumin levels, shorter 6-min walking distance, and lower leucine levels, highlighting the importance of monitoring nutritional status in these patients.

Calculating Protein Intake

• To calculate the recommended protein intake, first, calculate the patient's weight in kilograms: 172 lbs / 2.2 lbs/kg = 78 kg.
• Then, multiply the weight in kilograms by the recommended protein intake per kilogram: 78 kg x 0.6-0.8 g/kg/day = 46.8-62.4 g/day.
• This means that the patient should aim to consume 46.8-62.4 grams of protein per day, spread out over several meals to ensure adequate nutrition and prevent protein-energy wasting 2.