title: Back to the future: restricted protein intake for conservative management of CKD, triple goals of renoprotection, uremia mitigation, and nutritional health.
abstract: Lowering dietary protein intake (DPI) to approximately 0.6-0.8 g/kgBW/day may be renoprotective through various mechanisms, and it has been recommended in patients with non-dialysis-dependent chronic kidney disease (NDD-CKD) as a means to also control various metabolic consequences of advanced CKD, such as uremic symptoms, hyperparathyroidism, hypertension, hyperkalemia, and hyperphosphatemia. A meta-analysis in this issue of the Journal suggests that low-protein diet is effective and safe when used to retard progression of CKD and alleviate uremic complications. A potential deleterious consequence of lowering DPI in this population is the development or worsening of protein-energy wasting (PEW), which can contribute to poor clinical outcomes such as higher mortality and morbidity. There is currently insufficient high-level evidence to determine the ideal level of DPI in patients with NDD-CKD with high risk of PEW. For the time being we recommend a DPI of 0.6-0.8 g/kgBW/day, and increasing this as needed on an individual basis in patients with PEW. Further examination of this dilemma in randomized controlled clinical trials will be necessary.
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, 956 Court Avenue, Memphis, TN, 38163, USA.|Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
authors.affiliation: Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine Medical Center, Orange, CA, USA. kamkal@ucla.edu.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000072700:Conservative Treatment / Q000379:methods; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D006040:Goals; D006801:Humans; D009751:Nutritional Requirements; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000209:etiology* / Q000517:prevention & control; D051437:Renal Insufficiency / Q000150:complications / Q000178:diet therapy*; D014511:Uremia / Q000178:diet therapy
keywords: Chronic kidney disease; Low-protein diets; Nutritional supplements; Protein–energy wasting