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Dietary Protein and Declining Kidney Function

Kidney art

Rosie, aged 71, went to her physician for a follow up for management of type 2 diabetes. Routine blood work found that Rosie’s glomerular filtration rate (GFR) had declined over time to 47 mL/min/1.73 m2, indicating that she has stage 3a chronic kidney disease (CKD).1 Rosie was stunned and immediately asked her doctor how she could help prevent her kidney function from worsening. The physician provided her with some general information about managing her blood glucose levels and referred her to a registered dietitian nutritionist (RDN).

Rosie is not alone. Although it is common in the U.S. (approximately 15% of adults have CKD)2, as many as 9 in 10 adults with CKD are not aware that they have it.2 When a person is newly diagnosed they ay be overwhelmed and worried about what the future holds. Medical nutrition therapy (MNT) is the cornerstone treatment for managing CKD and its complications3 and compassionate delivery of nutrition information can help patients adapt to their new reality.

Rosie schedules an appointment with Maya, an RDN that is Board Certified as a Specialist in Renal Nutrition. Rosie is unsure what to expect and is apprehensive when she learns that one way to help prevent a continued decline in kidney function is to make changes in her diet. Maya tells her that people who receive MNT provided by an expert renal dietitian show less decline in GFR than those who don’t.3 Maya learns that Rosie enjoys meat, dairy foods and legumes regularly. After a comprehensive nutrition assessment and with Rosie’s input, Maya decides to focus on dietary protein in her first visit with Rosie.

The KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 update recommends 0.6 to 0.8 g/kg body weight for people with stage 3 CKD and diabetes to reduce their risk for ESRD.4 This means Rosie, who weighs 144 pounds, needs only 39 to 52 grams of protein daily, a significant change from her current eating habits.

Maya and Rosie discuss ways Rosie can reduce her protein intake and improve the quality of the protein she consumes. Rosie learns that consuming plant protein over animal protein results in less uremic toxins and improves the gut microbiome.3 Maya gently encourages Rosie to reduce her protein intake and change her dietary sources of protein gradually. She and Rosie brainstorm some options for lower protein meals and ways to include more plant and less animal protein in her diet. Rosie is receptive and embraces the challenge of dietary change, hoping she can maintain her kidney function for as long as possible.

For more information about nutrition and chronic kidney disease, consider our program on Nutrition Care for Patients with Kidney Disease, available for purchase at beckydorner.com/product/nutrition-care-for-older-patients-with-kidney-disease.

References

  1. Gonyea JE, Sparks B. Overview: Pathophysiology of the kidney. In: Gonyea JE, Phillips SC, eds. Clinical Guide to Nutrition Care in Kidney Disease. Third edition. Chicago IL: Academy of Nutrition and Dietetics; 2023: 1-7.
  2. Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States. 2021. Atlanta GA: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2021. https://www.cdc.gov/kidneydisease/pdf/Chronic-Kidney-Disease-in-the-US-2021-h.pdf.
  3. Harvey S, Leonberg K, Prato S. Nutrition management in chronic kidney disease stages 1 through 5. In: Gonyea JE, Phillips SC. Clinical Guide to Nutrition Care in Kidney Disease. Third Edition. Chicago IL: Academy of Nutrition and Dietetics; 2023: 33-48.
  4. Ikizler TA, Burrowes JD, Byham-Gray LD, et al; KDOQI Nutrition in CKD Guideline Work Group. KDOQI clinical practice guideline for nutrition in CKD:2020 update. Am J Kidney Dis. 2020;76(3)(suppl 1):S1-S107. https://www.ajkd.org/article/S0272-6386(20)30726-5/fulltext.

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