Asking chronic kidney disease (CKD) patients to follow 6 tips may help them manage their protein intake better than standard dietary advice, a small Italian study suggests.

Investigators led by Eleonora Riccio, MD, and Antonio Pisani, MD, of University Federico in Naples, Italy, randomly assigned 57 discharged CKD patients (stage 3b-5) to the 6-tips diet or a standard diet low in protein (0.8 g/kg/day). None of the patients received individual counseling from a dietitian.

The tips were based on the same principles of the standard diet (i.e., choose foods low in protein, sodium, and phosphate, and consume moderate food portions), but in easy-to-follow steps for patients eating typical Southern Italian foods:

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  1. Do not add salt during cooking or at the table.
  2. Avoid salami, sausages, cheese, dairy products, and canned foods.
  3. Replace noodles and bread with low protein alternatives.
  4. Eat 4–5 servings of fruits and vegetables daily.
  5. Meat, fish, or eggs are allowed once a day in a reasonable quantity.
  6. Once or twice a week, noodles with legumes may be eaten in place of meat, fish, or eggs.

After 6 months, the metabolic profile of patients on the 6-tips diet was better than those on the standard diet, according to results published online in Clinical and Experimental Nephrology. Although both diets progressively reduced protein intake and urinary excretion of nitrogen and phosphate, the effect was more pronounced in the 6-tips group. Plasma levels of phosphate, bicarbonate, parathyroid hormone, and urinary sodium chloride stayed stable for all patients.

At baseline, both groups were comparable with respect to sex, body weight, blood pressure, protein intake, estimated glomerular filtration rate, and treatments. Patients also took prescribed medication throughout the study, including phosphate binders.

Additionally, researchers observed that more patients adhered to the 6-tips diet: 70% vs. 44%. Adherence was defined by a consistent protein intake of 0.7-0.9 g/kg/day.

Patient adoption of low protein diets has been historically poor, prompting a need for alternatives. “These data, however, clearly suggest that the [6-tips diet], beyond its metabolic efficacy, is certainly better accepted than the usual diet, probably for its simplicity…,” the researchers noted. They emphasized that dietitians are valuable and should be sought when available, especially when protein intake needs to be reduced to 0.6 or 0.3 g/kg/day.

The investigators acknowledged that the tips are best suited to patients eating a Western-style diet. Future studies need to probe patients’ actual nutrient intake, such as the quality of protein and the amount of produce eaten.


  1. Pisani, A; Riccio, E; Bellizzi; Vincenzo; et al. Clinical and Experimental Nephrology, October 9, 2015; doi: 10.1007/s10157-015-1172-5.