A low protein diet of vegetable proteins along with reduced intake of specific micronutrients should be recommended to stage 3-4 CKD patients, researchers say.

For chronic kidney disease (CKD) patients, an individualized low protein diet might delay the start of renal replacement therapy and reduce cardiovascular risks, a recent study suggests.

A team led by Silvia Lai, MD, of Sapienza University in Rome, Italy, evaluated renal function, lipid profile, mineral metabolism, inflammatory indices, and acid-base balance in 16 stage 3-4 CKD patients before and after implementation of dietary interventions. The diet consisted of reduced protein consumption, adequate daily calories (30-35 kcal/kg), and regulated intake of calcium, phosphorus, sodium, and potassium. Base-inducing proteins from vegetables were preferred to reduce serum phosphorus and uremic toxins and improve metabolic acidosis. The diet was tailored to each patient, taking into consideration estimated glomerular filtration rate, body mass index, and food intake.

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After 12 months, the researchers observed significant increases of plasma bicarbonate and vitamin D levels and significant reductions of serum phosphorus and C-reactive protein. Other patient factors that improved, but not significantly, included functional muscle mass and cholesterol and triglyceride levels. Kidney function remained stable with a reduction of urinary protein excretion.

“Low protein intake alone, although relevant, represents only one part of the nutritional treatment in CKD. Indeed, a dietetic intervention with reduced energy, saturated fats, salt, proteins, and specific micronutrients (phosphorus, sodium, potassium, etc.) should be strongly recommended to improve metabolic derangements, renal outcome, and cardiovascular risk,” the investigators wrote in European Review for Medical and Pharmacological Sciences. Nutritional interventions that target obesity, for example, might reduce CKD progression.

The investigators recommended future randomized studies involving larger numbers of patients, a control group, and use of solid end points rather than surrogate markers.


  1. Lai S, Molfino A, Coppola B, et al. Effect of a Personalized Dietary Intervention on Nutritional, Metabolic and Vascular Indices in Patients With Chronic Kidney Disease. European Review for Medical and Pharmacological Sciences 2015;19:3351-3359.