Dietary Recommendations for Individuals with Proteinuria

Protein Intake

The American Journal of Kidney Diseases recommends a protein-restricted diet of 0.8 g/kg body weight per day to reduce proteinuria and slow progression of kidney disease 1, 2
Target protein intake should be 0.8 g/kg body weight per day for individuals with proteinuria and chronic kidney disease (CKD) stages 1-4 1
For individuals who cannot maintain adequate caloric intake with this level of protein restriction, intake up to 0.75 g/kg/day may be prescribed 3
High-protein diets (>20% of total calories from protein) should be strictly avoided as they increase albuminuria and may accelerate loss of kidney function 1, 4

Protein restriction reduces glomerular hyperfiltration and intraglomerular pressure, which are mechanisms of kidney damage induced by excess dietary protein 1
Studies show that even modest protein restriction (0.89 vs 1.02 g/kg/day) substantially reduced the risk of end-stage kidney disease or death (RR 0.23) in people with diabetes and CKD 1
Meta-analyses demonstrate that low-protein diets reduce risks of loss of kidney function (measured by GFR decline) 2, increased albuminuria/proteinuria 1, and progression to end-stage kidney disease 1, 5

Consider replacing some animal protein with plant protein sources 2
Some studies suggest beneficial effects from plant protein compared to animal protein in reducing proteinuria 6, 7
When using plant proteins, ensure adequate essential amino acid intake through variety 2

Maintain adequate caloric intake (approximately 35 kcal/kg/day) when restricting protein to prevent malnutrition 3
Limit saturated fatty acids and trans-unsaturated fatty acids to <10% (and preferably <7%) of energy intake 6, 7
Consider incorporating monounsaturated fats which may be beneficial for those with metabolic syndrome 7
Limit sodium consumption to <2,300 mg/day 8
For individuals with elevated triglycerides, consider supplementation with fish oils containing omega-3 fatty acids 7

Protein restriction appears more beneficial in type 1 diabetes than type 2 diabetes, though fewer studies have been conducted in type 2 diabetes 1
For individuals with very advanced CKD (GFR <25 mL/min) who are not on dialysis, a more restricted protein intake of 0.6 g/kg/day may be considered 3
Avoid high-protein/low-carbohydrate diets which are particularly risky for patients with diabetes as they can accelerate progression of diabetic kidney disease 4

Nutritional intervention should be implemented by personnel with expertise in dietary management 3
Monitor nutritional status regularly to prevent malnutrition 3
Combine dietary protein restriction with conventional nephroprotective therapy (ACE inhibitors, blood pressure control) for optimal results 1