Nephrology · 5 h ago
Low protein intake linked to kidney failure and mortality in CKD cohort
A prospective South Korean cohort study followed 1,861 adults with non-dialysis chronic kidney disease (CKD) for a median of 9.3 years. Protein intake below 0.6 g/kg/day was associated with higher risks of kidney failure requiring replacement therapy and all-cause mortality than intake of at least 1.2 g/kg/day; the observational findings do not establish causation.
- Cohort included 1,861 adults with non-dialysis CKD.
- Median follow-up was 9.3 years.
- Intake below 0.6 g/kg/day was associated with higher KFRT risk.
- Observational results do not establish causality or an optimal target.
Researchers analyzed data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease, which enrolled patients with CKD stages 1 to predialysis stage 5 at nine tertiary hospitals between 2011 and 2016. Baseline daily protein intake was estimated using 24-hour urinary nitrogen excretion and grouped into five categories. The primary outcome was kidney failure requiring replacement therapy (KFRT); secondary outcomes were all-cause mortality and major adverse cardiovascular events (MACEs). Follow-up ended in January 2024.
Among 1,861 participants (mean age, 53.7 years), median follow-up was 9.3 years. Compared with intake of at least 1.2 g/kg/day, intake below 0.6 g/kg/day was associated with higher risk of KFRT (subdistribution hazard ratio [sHR], 1.42; 95% CI, 1.09-1.85) and all-cause mortality (sHR, 2.17; 95% CI, 1.17-4.03). The lowest-intake group was not associated with MACEs. The investigators also reported a nonlinear association, with excessively low intake linked to higher KFRT risk.
As a prospective observational study, the findings cannot show that low protein intake caused these outcomes. The results do not establish an optimal intake target, but raise concern about rigid restriction in this population and support attention to nutritional status when managing dietary protein. Applicability beyond this South Korean cohort is uncertain.
In practice
For adults with non-dialysis CKD, this cohort raises concern that very low protein intake may be associated with worse outcomes: intake below 0.6 g/kg/day was linked to higher risks of KFRT and all-cause mortality than intake of at least 1.2 g/kg/day. These observational associations do not show that low intake caused harm, identify an optimal protein target, or justify a specific change in dietary advice. The findings are from a South Korean cohort and should be interpreted with attention to nutritional status and applicability to other populations.
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JAMA Network Open: Low Daily Protein Intake and Risk of Kidney Failure and Mortality in Chronic Kidney Disease ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.