Dietary protein intake and chronic kidney disease

Abstract

Purpose of review High protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration. This can cause damage to glomerular structure leading to or aggravating chronic kidney disease (CKD). Hence, a low protein diet (LPD) of 0.6–0.8 g/kg/day is often recommended for the management of CKD. We reviewed the effect of protein intake on incidence and progression of CKD and the role of LPD the CKD management. Recent findings Actual dietary protein consumption in CKD patients remain substantially higher than the recommendations for LPD. Notwithstanding the inconclusive results of the Modification of Diet in Renal Disease (MDRD) study, the largest randomized controlled trial to examine protein restriction in CKD, several prior and subsequent studies and meta-analyses including secondary analyses of the MDRD data appear to support the role of LPD on retarding progression of CKD and delaying initiation of maintenance dialysis therapy. LPD can also be used to control metabolic derangements in CKD. Supplemented LPD with essential amino acids or their keto-analogs may be used for incremental transition to dialysis especially in non-dialysis days. An LPD management in lieu of dialysis therapy can reduce costs, enhance psychological adaptation, and preserve residual renal function upon transition to dialysis. Adherence and adequate protein and energy intake should be ensured to avoid protein-energy wasting. Summary A balanced and individualized dietary approach based on LPD should be elaborated with periodic dietitian counselling and surveillance to optimize management of CKD, to assure adequate protein and energy intake and to avoid or correct protein-energy wasting.

Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients with Obesity and Mild Kidney Failure

“…Conversely, BUN was slightly increased, most likely as a consequence of increased protein metabolism as previously described [29], with again no difference between the two groups. Current guidelines are inconclusive regarding recommended dietary protein intake in patients with early stages of CKD, with some suggesting .8 g/kg body weight as the optimum [30], and others recommending up to 1.4 g/kg body weight [31]. Recent evidence suggests that the impact of dietary protein on renal function may depend on the protein source, with red meat intake being harmful in a dose dependent manner, and other protein sources such as poultry, fish, egg and dairies not showing such a deleterious effect [32].…”

Low‐protein diet for conservative management of chronic kidney disease: a systematic review and meta‐analysis of controlled trials

“…5 Century-old evidence suggests that lower dietary protein intake may help with CKD management including slowing its progression, improving albuminuria, and controlling uraemia. [6][7][8][9] However, results from the Modification of Diet in Renal Disease study in 1994 were inconclusive with regards to the efficacy of a low-protein diet (LPD) in slowing the rate of CKD progression. 10 Several meta-analyses that focused on the rate of CKD progression showed favourable but modest effects of an LPD.…”

An unusual use of personal insulin pump by a patient with type 1 diabetes on a ketogenic diet — a case report

“…It should be emphasized that due to the lack of randomized, prospective trials assessing the safety of the ketogenic diet, its impact on individual metabolic pathways, the body composition by percent of mass or long-term systemic effects is not known. However, it has been proven that excessive protein supply may adversely affect kidney function in people with reduced renal filtration, and patients with type 1 diabetes are at particularly high risk of this complication [20,21]. In addition, high-fat products contribute to the progression of atherosclerotic lesions and increased visceral fat, which increases insulin resistance [22].…”