Protein restriction in nondialysis chronic kidney disease patients

In adults with nondialysis chronic kidney disease (CKD), dietary management plays a central role in conservative treatment. Dietary interventions, particularly protein restriction, play pivotal roles in mitigating intraglomerular hypertension, slowing disease progression, alleviating uremic symptoms, and postponing the initiation of kidney replacement therapy. According to the KDIGO 2024 and KDOQI 2020 guidelines, protein intake in CKD should be tailored to disease stage, with strategies spanning from standard low-protein diets to very-low-protein diets supplemented by essential amino acids or ketoacid analogs. Plant-based nutrition has emerged as a promising strategy, offering renoprotective and cardiometabolic benefits, although concerns remain regarding hyperkalemia, nutritional adequacy, and long-term adherence. This article summarizes the evidence for protein restriction, supplementation strategies, and the impact of plant-centered nutrition, emphasizing the importance of individualized, patient-centered nutrition therapy under professional supervision to optimize outcomes and minimize risks in CKD care.