THURSDAY, April 30, 2026 (HealthDay News) -- For adults with chronic kidney disease (CKD) stage 3 or 4, lower dietary protein intake (DPI) is associated with lower dialysis risk, with no indication of nutritional harm, according to a study published online April 28 in JAMA Network Open.
Ilia Beberashvili, M.D., from the Yitzhak Shamir Medical Center in Zerifin, Israel, and colleagues conducted a retrospective cohort study involving adults with CKD stages 3 and 4. The association of objectively measured DPI, assessed using 24-hour urinary nitrogen excretion and normalized to adjusted body weight (normalized DPI [nDPI]), with long-term kidney and clinical outcomes was examined. Participants were stratified by an nDPI threshold of 1.0 g/kg/day.
A total of 530 patients were included in the matched analysis (265 per group). The researchers found that the lower nDPI group had a lower risk for the composite outcome (50 percent or more decline in estimated glomerular filtration rate [eGFR], initiation of long-term dialysis, or all-cause mortality; hazard ratio, 0.77), mainly due to fewer dialysis initiations (hazard ratio, 0.65). Low nDPI remained associated with lower composite risk in adjusted Cox models (hazard ratio, 0.75). No significant between-group differences were seen in eGFR or albuminuria slopes in longitudinal models; in the low-nDPI group, eGFR decline was numerically slower (slope difference, 0.152 mL/min/1.73 m2/y). There were no differences observed in nutritional markers.
"These findings suggest that modest protein restriction, even above traditionally recommended thresholds, may confer renal protection without compromising nutritional status in CKD management in clinical practice," the authors write.
