We all know a good diet (specifically low protein kidney diet for some) is crucial to being healthy. 

That's true for anyone, anywhere. It doesn't matter what your age is or the state of your health - everyone needs to eat well to live well.

But when you have chronic kidney disease (CKD), what is healthy for you may not be the same as the average person. 

While most essential nutrients are necessary for optimum health, one of the nutrients you would need to watch out for, however, is protein.

In this article, we'll talk about how much protein you should be eating according to your CKD stage. We'll also go over some diet tips that can help you keep your protein intake in check.

But first, let's find out why you need to watch your protein consumption in the first place.

Why is managing protein levels important when you have CKD?

Protein is an important nutrient that you need to keep your body functioning. It is the main component to build and repair muscles and fight infection, among other things.

But when your body uses protein, it produces waste products. When you have CKD, your kidneys can no longer filter out these wastes properly, causing them to build up in your body.

The more protein you eat, the harder your kidneys need to work to get rid of the waste that is generated. Overworking your kidneys in this way can cause them to wear out faster.

How do I know if my protein level is high?

One way to find out is to check your lab test results. If you have high blood urea levels, that means the protein wastes are accumulating in your blood.

Having protein in your urine is also a signal that you should cut back on your protein intake. You might also start experiencing symptoms.

What are the effects of high protein levels in CKD?

Excess protein waste in your body can cause all kinds of symptoms, like:

  • Weakness
  • Nausea
  • Loss of appetite
  • Taste changes / “metallic” taste in your mouth

As previously mentioned, eating too much protein overworks your kidneys, which may cause them to deteriorate faster.

What are the recommended protein levels for each CKD stage and those on dialysis?

How much protein you should eat is determined by many factors. There may be specifics regarding your condition that need to be taken into account.

The best thing to do to find out your recommended protein intake is to consult with a renal dietitian.

But if you want to know what you can do right now, we've put together some general guidelines you can start with. 

a.) For CKD stages 1 and 2 (GFR 60 - 90)

Protein limit:
0.8 grams per kilogram of body weight

To show you how this math works, let's use an example. Say you weigh 70 kilograms. Multiply 70 with 0.8 and you'll get your protein limit in grams:

70 x 0.8 = 56 grams of protein

That means you should stick to 56 grams of protein (or less) every day.

b.) For CKD stages 3 to 5 (GFR 59 and lower)

Protein limit:
0.55 - 0.60 grams per kilogram of body weight

The same computation for CKD stages 1 and 2 applies here. Multiply your body weight to 0.55 and 0.60 to get the range of your recommended protein intake.

If you weigh 70 kilograms, you'll have the following computations:

70 x 0.55 = 38.5
70 x 0.60 = 42.0

That means you should limit yourself to 38.5 to 42 grams of protein per day.

c.) For CKD stages 3 to 5, and with diabetes

Protein limit:
0.60 - 0.80 grams per kilogram of body weight

If you have diabetes, your recommended protein intake is a bit higher. This helps with glycemic control and in maintaining a stable nutritional status.

So at 70 kilograms, you'll have:

70 x 0.60 = 42.0
70 x 0.80 = 56.0

You should limit your protein intake to 42 to 56 grams per day.

d.) For those on dialysis

Dialysis removes the protein waste products from the blood, so a waste buildup is less likely. Instead, protein intake needs to be increased. This is because dialysis can remove protein itself from the body, along with the wastes.

If too much protein is lost, it can lead to a deficiency and cause symptoms like fatigue and weight loss.

These are the recommended protein limits for those on dialysis: 

Hemodialysis: 

1.2 grams per kilogram of body weight per day 

Peritoneal dialysis: 

1.2 - 1.3 grams per kilogram of body weight per day

However, these numbers may change depending on the specifics of your condition. 

All these numbers are taken from various scientific sources. We’ve provided our references here in case you want to check them out yourself. For CKD stages 1 and 2, click here. For CKD stages 3 to 5 (with and without diabetes), click here. For dialysis, click here.

It is very important to consult with a renal dietitian and/or your healthcare team to find out how much protein you need.

Which foods are high in protein and low in protein?

To effectively plan a low protein diet, it's helpful to have an idea of how much protein food items contain. 

In general, there are two main classifications for protein sources:

- Animal products (fish, shellfish, poultry, eggs, meat, and dairy)

Considered “high quality protein.” These contain all the essential amino acids. Amino acids are considered the building blocks of protein.

- Plant products (beans, nuts, whole grains, bread, cereals, rice, pasta)

Considered "low quality protein" since they may be low on one or more of the essential amino acids. These typically don't contain as much protein as animal products.  However, you can pair one plant source with another plant source to make it a “complete protein” meal.

Just don’t forget to check the servings sizes of anything that you consume. Even a low protein food can cause you to go over your limit if you eat too much!

Should I switch to a plant-based diet?

It's true that high quality protein like red meat, fish, poultry, and dairy products are easier for your body to use. But animal proteins are also high in saturated fat and cholesterol. And many of these foods are usually cooked with sodium, which you should also be limiting. This is why you may want to try a plant-based diet. Here are tips in transitioning to a kidney-friendly plant-based diet.

According to this article in the European Medical Journal, a plant-dominant, high-fiber, low-protein diet can help maintain the health of the microorganisms in your gut. When these microorganisms are in a disrupted state, it can lead to a large increase in uraemic toxins. These toxins have been associated with the development of cardiovascular disease, CKD progression, and a higher mortality rate in CKD patients.

Plant proteins are high in fiber and low in saturated fat. They may be low on some amino acids, but that's something a good diet plan can fix! By consuming a healthy variety of plant-based foods, you can avoid a deficiency of any amino acids. 

It is very possible to fulfill your protein needs with plant-based sources. You can also check out kidney-friendly plant-based diet grocery shopping. We've compiled some food items you can check out to get started.

senior at vegetable section

Common plant-based alternative protein sources:

  • Soy products: These include tofu, soy milk, soy cheese, and tempeh (A type of soy paste)
  • Beans and legumes: Examples are red beans, kidney beans, black beans, chickpeas, and lentils.
  • Nuts and seeds: Choose from almonds, cashews, walnuts, sesame seeds, flax seeds, chia seeds
soy products

This list is taken from one of our other articles on plant-based diets. You can check it out here.

And if you're interested in transitioning to a plant-based diet, find out more here.

What changes can I apply to make a low protein diet work?

Usually, we think of meat dishes as the "main" components of a meal, while other items are considered "sides." For a low protein diet to work, your mindset plays a major role in effecting change.

You should start considering meat products as the side dishes in your meals.

senior adding vegetables to plate

For someone with CKD, vegetables and grains should become the main component of each meal.

Still, a low protein diet doesn't have to be an entirely vegetarian one. You can still enjoy your favorite meat dishes with one or two of these low protein tweaks.

Low Protein Diet Tips

For soups:

  • Cream soups can be high protein because of the dairy content. Use milk substitutes instead as a low protein alternative

For sandwiches:

  • Cut your meat into thin slices. This way, you can distribute their flavor more evenly throughout your sandwich. Plus, it looks like there's more meat!

For mains and other dishes:

  • Decrease the amount of meat in casseroles, but increase the starch, pasta, or rice to keep them filling.
  • Try kebabs with smaller pieces of meat spaced between bigger servings of vegetables.
  • Increase the variety and amount of vegetables in your recipes instead of meat.
  • Use condiments, spices, and herbs to add flavor instead of protein-rich foods. Just remember to keep an eye on your sodium intake as well.

And if you need proof that low-protein diet options can taste good, here are some recipes you can try:

Low Protein Recipes

This is a great low protein option. Eat it as a snack or pair it with toast or a green salad (like the one below) for a light meal.

Not only is this salad delicious, it also has a satisfying crunch from the fresh pears and nuts. With only 6 grams of protein per serving, it's definitely worth a try!


One last thing...

You've reached the end of this article. We know it runs a little long, so good job! Before you go, we'd like to give you one last reminder:

There is no one-size-fits-all instruction manual for low protein dieting.

Figuring out the right diet is a lot like trying on a pair of shoes. You can have a general idea of what might fit, but you never really know if it's right for you until you try it on.

So the first thing you need to do is to find out for yourself how much protein you should really be taking in.

Do the research, crunch the numbers, and consult with your doctor or dietitian. After you’ve done that, everything you've learned in this article would make more sense, and you can easily apply them to fit your needs.

Find out what works well for you and what doesn’t. Only then can you take the necessary steps to improve your diet, and, essentially, your kidney health.

We'll be rooting for you!

Sources:

Breaking Down Dietary Protein: What is it?
https://www.kidney.org/newsletter/breaking-down-dietary-protein

Getting More Protein While on Dialysis
https://www.kidney.org/atoz/content/getting-more-protein-while-dialysis

Low-Protein Recipes
https://www.kidney.org/atoz/content/lowprotrecipes

Nutritional Management of Patients with Chronic Kidney Disease Through Low-Protein Diets
https://www.emjreviews.com/nephrology/article/nutritional-management-of-patients-with-chronic-kidney-disease-through-low-protein-diets/

Protein intake in patients with renal failure: comments on the current NKF-DOQI guidelines for nutrition in chronic renal failure

https://pubmed.ncbi.nlm.nih.gov/11422915/

Understanding the Renal Diet: Protein
https://kidneyhi.org/dietitian-blog/how-much-protein-do-i-need-on-a-ckd-diet