First, Do No Harm: Critical Appraisal of Protein Restriction for Diabetic Kidney Disease

Abstract

Low-protein diets have been recommended as diet therapy for the management of chronic kidney disease; however, its effect on chronic kidney disease has not been scientifically proven. Although several studies have reported significantly more favorable results with low-protein diet than with normal-protein diet, the renal protective effects of low-protein diets are still unclear in diabetic patients with chronic kidney disease. Moreover, some studies have reported that extremely low-protein diets may increase the risk of mortality. Thus, this paper describes the effectiveness and safety of low-protein diets for patients with diabetic kidney disease by reviewing the historical background of different low-protein diets that were critically examined in several studies.

Plant-based diets for CKD patients: fascinating, trendy, but feasible? A green nephrology perspective

“…In spite of the fact that diabetic patients represent one of the major, if not the most common, subset of patients with advanced CKD, very few recent studies have addressed this population, As a result, the old caveats on a higher risk of malnutrition, gathered in older populations mainly composed of type 1, intensively proteinuric diabetic patients, are still reflected in the current guidelines, which warn against an overly strict protein restriction. The recommendations are that these patients follow a “normal” protein diet at 0.8 g/kg/day of ideal body weight [ 49 , 99 , 100 ]. Nevertheless, the most recent KDIGO guidelines on the management of diabetic patients with CKD not on dialysis also suggest to keep a diet rich in plant-based proteins, vegetables and low in processed meats [ 100 ].…”