Protein and Kidney Disease

Lowering Dietary Protein Reduces Kidney Damage and Prevents the Progression of Kidney Disease

by Tanya Zilberter, PhD
Lowering dietary protein reduces protein excretion with urine, which in turn prevents continuing kidney damage and prevents progression.
The EURODIAB survey showed an association between high dietary protein intake and presence of kidney damage and suggested a positive benefit of restricted protein intake on nephropathy progression.
The current Position Statement of the American Diabetes Association:
"...to prescribe a protein intake approximately equal to the adult recommended dietary allowance (RDA) of 0.8g/kg body weight per day (~ 10 % of daily calories)...once the [kidney function] begins to fall, further restriction to 0.6g/kg body weight per day may prove useful in slowing decline..."
However, a couple of problems with this advice exist:

• There may be potential for protein malnutrition;
• There may be qualitative differences between proteins of animal and vegetable origin.
  

Another important dietary consideration is salt intake. In this regard ADA found it important to advise against so-called "Lo-Salt" preparations because they contain potassium chloride, which must be taken with caution. <>
And of course: "Any dietary advice should be given by trained staff."
References
1. Zatz R, Meyer T, Rennke HG, Brenner BM. Predominance of hemodynamic rather than metabolic factors in the pathogenesis of diabetic glomerulopathy. Proc Natl Acad Sci USA. 1985 ;82:5963-5967.
2. Toeller M, Buyken A, Heitkamp G et al. Protein intake and urinary albumin excretion rates in the EURODIAB IDDM complications study. Diabetologia. 1997;40:1219-1226.
3. Pedrini MT, Levey AS, Lau J, Chalmers TC. The effect of dietary protein restriction on the progression of diabetic and non diabetic renal diseases : a meta analysis. Ann Int Med. 1996;124:627-632.
4. American Diabetes Association. Clinical practice recommendations 2001: Diabetic nephropathy. Diabetes Care. 2001;24(suppl 1):S69-S72.