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Current therapy for progressive chronic kidney disease (CKD) includes interventions such as blood pressure control, the use of ACE inhibitors and angiotensin receptor blockers, and control of diabetes mellitus. These interventions may slow progressive loss of kidney function, but none of them are able to reliably halt or reverse it.

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Therefore, it is important to explore additional interventions to complement existing ones to lower the high incidence and prevalence of end-stage renal disease (ESRD) and to potentially improve survival in patients with CKD. Dietary protein restriction has been known to have potentially beneficial effects on progressive CKD, but it has not caught on as a widely applied and routine therapeutic measure.

The reasons for this are multiple, and include uncertainties about its benefits, difficulties with its implementation, convenience, and cost. There have been renewed efforts in the past decade to revitalize the field of nutritional interventions in CKD by exploring alternative strategies addressing the various impediments towards practical implementation.

These strategies need to be considered in the wider context of dietary interventions affecting nutritional status, protein-energy wasting (PEW), and, potentially, patient survival. We will hereby review the various available dietary interventions involving protein intake, and will discuss their theoretical benefits, the evidence supporting or refuting their efficacy, and practical considerations towards their use in everyday practice (Table 1).

Click to enlarge table