Cochrane for Clinicians

Putting Evidence into Practice

Low-Protein Diets for Adults Without Diabetes Mellitus Who Have CKD


Am Fam Physician. 2020 Dec 1;102(11):665-666.

Author disclosure: No relevant financial affiliations.

Clinical Question

In patients without diabetes mellitus who have chronic kidney disease (CKD), is a low-protein diet effective at preventing progression to end-stage renal disease (ESRD) or the need for dialysis?

Evidence-Based Answer

There is moderate-quality evidence that compared with low-protein diets (0.5 to 0.6 g per kg per day) or normal-protein diets (0.8 g per kg per day or more), very low-protein diets (0.3 to 0.4 g per kg per day) reduce the number of patients with advanced kidney disease (CKD stage 4 or 5) who progress to ESRD (i.e., the need for dialysis or transplant; relative risk [RR] = 0.65; 95% CI, 0.49 to 0.85). However, in patients with less advanced disease (CKD stage 3 or lower), low-protein diets do not appear to reduce the progression to ESRD compared with normal-protein diets (RR = 1.05; 95% CI, 0.73 to 1.53; low-certainty evidence).1 (Strength of Recommendation: B, based on inconsistent or limited-quality patient-oriented evidence.)

Practice Pointers

CKD is defined as abnormalities of the structure or function of the kidneys present for three months or more, often diagnosed initially by a glomerular filtration rate of less than 60 mL per minute per 1.73 m2.2 In 2016, an estimated 37 million adults in the United States had CKD, representing 15% of all U.S. adults.3 CKD is associated with a number of adverse health outcomes, including increased all-cause and cardiovascular-related mortality.2 Identifying interventions that may halt the progression of CKD to ESRD may lead to improved clinical outcomes and lower costs. Protein-restricted diets are thought to have nutritional benefits in patients with CKD, particularly in correcting metabolic acidosis and reducing the adverse effects of phosphate and sodium retention. This Cochrane review aimed to investigate whether low-protein or very low-protein diets were effective in preventing the progression of CKD and delaying the need for dialysis and/or transplant.1

This updated review included 17 randomized and q

Author disclosure: No relevant financial affiliations.


show all references

1. Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev. 2018;(10):CD001892....

2. Kidney Disease Improving Global Outcomes. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney International Supplements. 2013;3(1):1–150.

3. Centers for Disease Control and Prevention. Chronic kidney disease in the United States, 2019. Accessed October 13, 2019.

4. Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713–735.

5. Fouque D, Laville M. Low protein diets for chronic kidney disease in non diabetic adults. Cochrane Database Syst Rev. 2009;(3):CD001892.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at



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