Dietary Protein Intake Recommendations for Patients with Non-Dialysis Dependent CKD: What Should Healthcare Providers Do?

Protein intake is crucial to maintain human health, and an adequate quantity and quality of dietary protein intake (DPI) is particularly important in patients with chronic kidney disease (CKD). Both an insufficient amount of DPI (i.e., <0.6 g/kg body weight/day) and an excess amount of DPI (i.e., >1.3 g/kg body weight/day) pose potential health hazards in patients with CKD stages 3-5. Therefore, to optimize patient outcomes, healthcare providers should be familiar with the effects of both inadequate and excessive DPI in this population. The Kidney Disease Outcome Quality Initiative (KDOQI guidelines on DPI are rooted in detailed analyses of available scientific evidence and provide detailed recommendations regarding different dietary interventions strategies to achieve optimal quantity and quality of DPI. The more recent Kidney Disease Improving Global Outcomes (KDIGO) guidelines on CKD management have a substantially broader scope and include a relatively brief section on diet, recommending a DPI of 0.8 g/kg BW/day, emphasizing the need to avoid a DPI of >1.3 g/kg BW/day. Besides aiming for a DPI of ∼0.6-0.8 g/kg body weight/day in patients with CKD stages 3-5, successful practical implementation of dietary interventions requires an individualized approach which considers patient characteristics, such as socio-cultural norms, habitual dietary habits, and nutrition literacy as well as systemic factors such as feasibility and availability of interventions.