TOPLINE:

A personalised, moderately restricted low-protein diet was feasible in patients with advanced chronic kidney disease (CKD), with over 60% adherence. Patients who chose and followed the diet had a slower decline in kidney function and lower risks for all-cause mortality and dialysis initiation than those who did not follow the diet.

METHODOLOGY:Researchers conducted a study to assess the feasibility and effect of a personalised, moderately restricted low-protein diet on the progression of the disease, initiation of dialysis, decline in the estimated glomerular filtration rate (eGFR), and mortality in patients with advanced CKD (stages 4-5) who were followed up for at least 6 months.A total of 182 diet-naive patients (mean age, 71.21 years; 34.6% women) with advanced CKD, without active neoplasia, cachexia, or malnutrition, were offered a personalised, moderately restricted low-protein diet (0.6-0.7 g/kg/d), which included tailored nutritional counselling, one unrestricted meal per week, and controlled sodium, phosphorus, and energy intake.Regular one-on-one consultations created a continuous feedback loop to assess the real-world feasibility of the diet, and the nutritional team offered personalised food alternatives tailored to individual taste preferences and cultural backgrounds.TAKEAWAY:Among the 182 patients, 110 (60.4%) adhered to the low-protein diet (diet group), whereas 72 (39.6%) did not follow or were unable to comply with the diet (no-diet group).After a median follow-up of 18 months, the diet group had an 84% lower risk of requiring dialysis (crude hazard ratio [HR], 0.16; 95% CI, 0.07-0.39), a 78% lower risk for all-cause mortality (crude HR, 0.22; 95% CI, 0.06-0.72), and an 81% lower risk for the composite outcome of dialysis, mortality, or non-fatal cardiovascular events (crude HR, 0.19; 95% CI, 0.09-0.38) than the no-diet group.The diet group had a significantly slower annual decline in the eGFR than the no-diet group (-0.89 vs -2.65 mL/min/1.73 m2 per year; P = .0004).The diet group also showed better metabolic control, with higher levels of serum bicarbonate, calcium, and haemoglobin and lower levels of blood urea and serum phosphorus, while maintaining stable albumin levels and BMI, indicating no increase in malnutrition.IN PRACTICE:

“The implementation of LPD [low-protein diet] is feasible in over 60% of patients with advanced CKD and is associated with better hard outcomes over follow-up, especially progression to ESKD [end-stage kidney disease],” the author wrote.

SOURCE:

This study was led by Gisella Vischini, Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy. It was published online on November 07, 2025, in Clinical Kidney Journal.

LIMITATIONS:

This study used a retrospective design and did not include propensity score matching between the two groups. The assessment of drug and dietary treatment adherence relied on self-reporting, potentially introducing recall bias. The single-centre setting limited the generalisability of the findings.

DISCLOSURES:

This study did not report any source of funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.