Among 1,861 Korean patients with non-dialysis-dependent chronic kidney disease, a daily protein intake below 0.6 grams per kilogram of body weight is significantly associated with a 42% higher risk of kidney failure and a more than doubled risk of all-cause mortality, Medical Xpress reported. Researchers presented the findings at the American Society of Nephrology’s Kidney Week annual meeting in Denver and concurrently published them in JAMA Network Open.
Study Tracks Kidney Failure Risks Across Nine Years
The prospective cohort study utilized data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease, tracking participants across stages 1 through predialysis 5. Investigators analyzed patients with a mean estimated glomerular filtration rate ranging from 44.2 to 60.2 mL/min/1.73m2 at baseline, according to Renal and Urology News. Median follow-up lasted 9.3 years, during which 726 participants developed kidney failure requiring renal replacement therapy.
Patients consuming the lowest daily protein intake—less than 0.6 g/kg/day—faced a subdistribution hazard ratio of 1.42 for kidney failure requiring replacement therapy compared to those consuming more than 1.2 g/kg/day. The same severely restricted group experienced a subdistribution hazard ratio of 2.17 for all-cause mortality. However, researchers observed no statistically significant difference in major adverse cardiovascular events between the lowest and highest protein consumption groups.
Malnutrition Risks in Asian Patient Populations
Excessively low protein consumption did not provide a protective effect for kidney function, but instead correlated with a nonlinear increase in disease progression. Sang Heon Suh, M.D., Ph.D., from Chonnam National University Medical School in Gwangju, South Korea, and colleagues noted that strict dietary limits likely induce protein-energy wasting and sarcopenia.
Asian populations with lower body mass index and muscle reserves are particularly vulnerable to these conditions, according to the study authors. Persistent chronic inflammation from metabolic toxins in chronic kidney disease patients depletes protein and energy reserves, meaning severe dietary restriction accelerates tissue damage by consuming muscle mass and worsening inflammation.
Challenging One-Size-Fits-All Dietary Guidelines
Current guidelines from Kidney Disease: Improving Global Outcomes recommend a daily protein intake of 0.8 g/kg for adults with stage 3 through 5 chronic kidney disease who are not on dialysis. Soo Wan Kim, MD, PhD, and Seong Kwon Ma, MD, PhD, also from Chonnam National University Medical School, stated that the findings provide longitudinal evidence supporting the normalization of protein intake rather than traditional lower thresholds.
Low Protein/High Carb Diets Harm Your KidneysYour doctor may have told you to cut protein to save your kidneys. A new study of 1,861 kidney disease patients followed for 9 years found the opposite.The lowest protein group (under 0.6 g/kg a day) was linked to 42% more kidney…
The investigators suggested that the risks of adhering to a strict 0.6 g/kg/day threshold may outweigh the marginal benefits of reducing kidney workload, particularly for demographics where preserving muscle mass is paramount.
Common Questions Regarding Chronic Kidney Disease Diets
Why were patients previously advised to limit protein intake?
Metabolism of dietary protein generates toxins that healthy kidneys filter out, but declining kidney function in chronic kidney disease patients impairs toxin excretion, leading to historical recommendations for strict protein restriction.
What specific patient group did this study examine?
The research followed 1,861 participants diagnosed with chronic kidney disease stages 1 through predialysis 5 across nine university hospitals in South Korea, with an average patient age of 53.7 years.
Did the study find any link between low protein intake and heart events?
No. While low protein intake significantly increased the risks of kidney failure and overall mortality, researchers observed no association with major adverse cardiovascular events such as stroke or myocardial infarction.
Data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease covers the period from 2011 to 2016, with outcomes tracked over a median of 9.3 years.