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TOPLINE:

Among adults with nondialysis chronic kidney disease (CKD) stages III and IV, moderately restricting protein intake was associated with a reduced risk for adverse clinical outcomes — driven mainly by fewer dialysis initiations — and was not linked to worsening standard nutritional markers.

METHODOLOGY:

• Nutritional strategies — especially moderation of dietary protein intake (DPI) — remain underutilized to address the risk for adverse clinical outcomes in patients with CKD; the optimal DPI is also uncertain, with limited long-term data from routine care and ongoing concerns about nutritional harm.
• Researchers conducted a retrospective cohort study of 1441 patients with nondialysis CKD stages III and IV (mean age, 67.20 years; 35.2% female) to examine associations between objectively measured DPI and long-term kidney and clinical outcomes; exclusion criteria included an estimated glomerular filtration rate (eGFR) > 60 or < 15 mL/min/1.73 m², dialysis, or kidney transplantation.
• DPI was measured using 24-hour urinary nitrogen excretion and normalized to adjusted body weight (nDPI), with a median baseline value of 1.18 g/kg/d.
• Patients were categorized as having low nDPI (< 1.0 g/kg/d; n = 321) or high nDPI (≥ 1.0 g/kg/d; n = 1120); after propensity score matching, a subset of 530 patients was analyzed (265 per group).
• The primary outcome was a composite of time to first occurrence of ≥ 50% decline in eGFR rate (confirmed after ≥ 28 days), initiation of dialysis, or all-cause death; the maximum follow-up duration was up to 15 years, with a median of 67 months.

TAKEAWAY:

• In the matched cohort, low nDPI was associated with a 23% lower risk for the composite outcome than high nDPI (hazard ratio [HR], 0.77; 95% CI, 0.62-0.97); this association was largely driven by a 35% reduced risk for dialysis initiation (HR, 0.65; 95% CI, 0.42-0.99).
• After adjustment for age, sex, diabetes, BMI, eGFR, serum albumin levels, and urine albumin-to-creatinine ratio, low nDPI remained associated with a significantly lower risk for the composite outcome (HR, 0.75; 95% CI, 0.60-0.93), and the association reached statistical significance for dialysis initiation.
• Over time, eGFR declined in both groups, with a numerically slower decline in the low-nDPI group.
• No differences in nutritional markers were observed between the groups.

IN PRACTICE:

“[The study] findings suggest that modest protein restriction, even above traditionally recommended thresholds, may confer renal protection without compromising nutritional status in CKD management in clinical practice,” the authors of the study wrote.

SOURCE:

The study was led by Ilia Beberashvili, MD, Yitzhak Shamir Medical Center, Zerifin, Israel. It was published online in JAMA Network Open.

LIMITATIONS:

The retrospective nature of the study may have introduced selection bias and unmeasured confounding. The study lacked detailed data on specific diet prescriptions, counseling intensity, and adherence. It also lacked information on protein sources (animal vs plant).

DISCLOSURES:

No funding source was mentioned for the study, and no potential conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.