Protein Restriction in Renal Disease

Abstract

Abstract Early stages of renal disease alter the metabolism of nutrients and their end products. In addition, food intake is limited because of gastrointestinal distress, depression, superimposed illness, and restrictive diets. Treatment of chronic renal failure (CRF) is multifactorial and should focus on dealing with uremia, muscle wasting, metabolic acidosis, blood pressure, and adequate energy intake. Protein intake is a modulator of renal function. Conventional protein restriction of about 0.6 g/kg body weight/day has been recommended in patients with moderate CRF to reduce signs and symptoms of uremia and to delay the progression of renal disease. Like healthy individuals, CRF patients seem able to activate normal compensatory responses to dietary protein restriction in order to maintain lean body mass and nutritional status. Low‐protein diets do not seem to worsen survival during dialysis. In contrast, high dietary protein intake results in metabolic acidosis and anorexia. Anorexia, in turn, limits energy intake and reduces the efficiency of protein utilization. Thus, a low‐protein diet that approaches the minimal requirement for reducing anorexia while preventing malnutrition is a clinical challenge for the treatment of CRF patients not yet on dialysis. To successfully achieve the goals of protein‐restricted regimens, intensive nutritional counseling (at no less than 1‐ to 3‐month intervals) should be a routine component of care in this patient population.