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 in the CKD management. Recent findings Actual dietary protein consumption in CKD patients remains 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 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 ketoanalogs may be used for incremental transition to dialysis especially on nondialysis days. The 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 counseling and surveillance to optimize management of CKD, to assure adequate protein and energy intake, and to avoid or correct protein-energy wasting.
| Original language | English |
|---|---|
| Pages (from-to) | 77-85 |
| Number of pages | 9 |
| Journal | Current Opinion in Clinical Nutrition and Metabolic Care |
| Volume | 20 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2017 Jan 1 |
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Keywords
- glomerular hyperfiltration
- incremental hemodialysis
- low-protein diet
- progression of chronic kidney disease
- protein-energy wasting
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Nutrition and Dietetics
Cite this
Dietary protein intake and chronic kidney disease. / Ko, Gang Jee; Obi, Yoshitsugu; Tortorici, Amanda R.; Kalantar-Zadeh, Kamyar.
In: Current Opinion in Clinical Nutrition and Metabolic Care, Vol. 20, No. 1, 01.01.2017, p. 77-85.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Dietary protein intake and chronic kidney disease
AU - Ko, Gang Jee
AU - Obi, Yoshitsugu
AU - Tortorici, Amanda R.
AU - Kalantar-Zadeh, Kamyar
PY - 2017/1/1
Y1 - 2017/1/1
N2 - 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 in the CKD management. Recent findings Actual dietary protein consumption in CKD patients remains 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 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 ketoanalogs may be used for incremental transition to dialysis especially on nondialysis days. The 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 counseling and surveillance to optimize management of CKD, to assure adequate protein and energy intake, and to avoid or correct protein-energy wasting.
AB - 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 in the CKD management. Recent findings Actual dietary protein consumption in CKD patients remains 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 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 ketoanalogs may be used for incremental transition to dialysis especially on nondialysis days. The 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 counseling and surveillance to optimize management of CKD, to assure adequate protein and energy intake, and to avoid or correct protein-energy wasting.
KW - glomerular hyperfiltration
KW - incremental hemodialysis
KW - low-protein diet
KW - progression of chronic kidney disease
KW - protein-energy wasting
UR - http://www.scopus.com/inward/record.url?scp=84994193704&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84994193704&partnerID=8YFLogxK
U2 - 10.1097/MCO.0000000000000342
DO - 10.1097/MCO.0000000000000342
M3 - Review article
C2 - 27801685
AN - SCOPUS:84994193704
VL - 20
SP - 77
EP - 85
JO - Current Opinion in Clinical Nutrition and Metabolic Care
JF - Current Opinion in Clinical Nutrition and Metabolic Care
SN - 1363-1950
IS - 1
ER -