The Low Protein Diet for Kidney Disease: Expert Tips from a Dietitian

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A low protein diet is a popular conversation within the kidney disease world. And while it may be suitable for some with CKD, it’s not a solution for all. In this article, we will cover what a low protein diet for kidney disease is, who it’s appropriate for, who it’s not appropriate for, and safe guidelines. Be sure to speak with your own dietitian or healthcare professional before starting this or any other type of diet change.

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What is a low protein diet?

A low protein diet is a diet in which the daily protein allowance is limited to below the general nutrition guidelines.

The general recommendation for adequate protein is 0.8 – 1.0 grams of protein per kilogram of body weight.

KDOQI Guidelines

According to The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) 2020 Nutrition Guidelines, a low protein diet may be:

• 0.6 to 0.8 grams protein per kilogram body weight
• 0.55 to 0.6 grams of protein per kilogram body weight OR
• 0.28 to 0.43 grams protein per kilogram body weight plus ketoanalogues to meet protein needs

The specific amount determined in this range will include factors such as age, activity level, stage, and cause of kidney disease.

The KDOQI Guidelines also stress the importance of close clinical supervision for any type of low protein diet.

KDIGO Guidelines

The Kidney Disease: Improving Global Outcomes (KDIGO) workgroup published 2024 guidelines to include protein recommendations.

In their guidelines, it is recommended to maintain a protein intake of 0.8 grams per kilogram body weight.

They do acknowledge that certain CKD patients may benefit from a low protein diet with ketoanalogues under close supervision.

Calculate your protein goal

For your convenience, we have included a calculator to help you get a starting point.

This low protein diet calculator will provide an estimate of both:

• normal protein daily goal, between 0.8 and 1.0 grams per kilogram
• low protein diet daily range of 0.6 to 0.8 grams protein per kilogram

It is important to discuss your protein needs with a physician and/or registered dietitian to ensure you get the right amount.

The calculator will estimate protein needs based off of your weight in either pounds or kilograms.

This calculator does not take in medical considerations and should only be used for educational purposes. Discuss appropriate protein needs with your healthcare provider.

What if my weight is out of range?

Bodies come in all different sizes. And while it may be possible to achieve a healthier weight, severe diets and restrictions are not the solution.

It is important to discuss your protein needs with a qualified healthcare professional, like a registered dietitian.

Your protein needs may need to be adjusted to a target weight. However, only a dietitian would be able to determine this within a comprehensive nutrition assessment.

Benefits of a Low Protein Diet

A low protein diet can provide several proven benefits for those with kidney disease. 

Research has shown that it can reduce protein in the urine (proteinuria), improved cholesterol and lipid levels, and even better glucose control for those with diabetes and early-stage CKD.

For many people with kidney disease, urea is a big issue. The amount of urea produced from protein metabolism is lower when eating less protein.

This can then lower blood urea nitrogen (BUN) levels to help keep kidneys safe.

Other benefits include;

• Keep kidney function longer
• Less protein in the urine
• Lower risk of metabolic acidosis
• Less oxidative stress
• Less insulin resistance
• Lower/controlled blood pressure
• Less uremic toxins
• Better control of phosphorus

Are there risks with a low protein diet?

As with other types of restrictive diets, there are risks that come with a low protein diet.

If a low protein diet is not monitored by healthcare professionals, there can be potential side effects.

Weight loss

When reducing the amount of protein, there is a risk of not getting enough calories. This can lead to unintentional weight loss.

When weight loss happens too quickly or in an unsafe manner, it can lead to muscle breakdown.

Even if weight loss is a goal for a person, doing so in an unhealthy way will not be healthy in the long-term.

Nutrition Deficiencies

As with any limitation to a diet, there is a risk of not getting enough nutrients.

Many high protein foods not only provide protein, but other nutrients.

Examples include vitamin B12, iron, and calcium. Because of this, a low protein diet may lead to or progress anemia, one of the first signs and symptoms of kidney disease.

Who should follow a low protein diet?

While this type of diet may be helpful for chronic kidney disease, it doesn’t mean this is something everyone should try.

Studies have found a low protein diet to be beneficial for those in later stages of kidney disease, like stage 4 and stage 5.

It is important to have medical supervision when following a low protein diet. Ask your physician for a referral to a qualified renal dietitian who can monitor your nutritional status and support you.

Who should not follow a low protein diet?

While a low protein diet may be helpful for some with chronic kidney disease, it’s not always the case.

Here are some examples of situations in which a low protein diet would not be recommended.

Uncontrolled Diabetes

While diabetes and kidney disease often go hand-in-hand, a low protein diet is not always appropriate.

It’s best to focus first on blood sugar control if it is unmanaged and often high.

Hospitalized Patients

A patient that is or has recently been hospitalized is not stable for a low protein diet.

Protein needs should be determined by the hospital team, including physician and dietitian.

Dialysis Patients

Those with kidney failure on dialysis should not follow a low protein diet.

The dialysis process includes filtration of the blood, which removes some protein. That protein needs to be replenished. 

A dialysis diet requires approximately 1.0-1.2 grams per kilogram per day.

Certain Health Conditions

Some health conditions may require a moderate- or high-protein diet. These can be challenging conditions that require medical and nutritional guidance from a healthcare professional, like a registered dietitian.

For example, a low protein diet is not recommended for those with cancer. In these cases, it is especially important to work with a registered dietitian so that you get the right amount of protein for you.

Foods to include on a low protein diet

A low protein diet will include a variety of foods. Food groups considered low in protein include;

• Fruits
• Vegetables
• Whole grains
• Healthy fats

Other components of a low protein diet include items such as;

• Herbs
• Spices
• Condiments, sauces, and dips
• Coffee, tea, and other beverages

While it’s not a guarantee, many with late-stage kidney disease may need to limit potassium. Obviously, this will be something to pay attention to when it comes to increasing your fruits and vegetables.

Remember- there are plenty of low-potassium fruits and vegetables to enjoy. You may also include some high potassium foods as well, but it’s best to work with a dietitian to know how to do that safely.

You can learn more about a low potassium diet here.

Healthy Fats

It is critical to include healthy fats with a low protein diet.

Fat provides us with more calories per gram than either protein or carbohydrates. Because of this, they are helpful to achieve enough calories for energy.

Some of my favorite healthy fat sources include;

• Olive oil
• Avocado oil 
• Sesame oil
• Flaxseed oil
• Walnuts
• Pecans
• Macadamia nuts
• Avocado
• Hemp hearts
• Flaxseed (ground)
• Chia seeds
• Low-sodium olives

Foods to avoid on a low protein diet

Foods naturally high in protein tend to come from animal meat.

By reducing or eliminating animal proteins, you’ll reduce your protein intake.

Examples of high protein foods include;

• Chicken/poultry
• Fish/shellfish
• Beef
• Lamb
• Game meats
• Milk/dairy
• Eggs

Additionally, high-protein plant foods such as tempeh, legumes and beans may need to be limited as well. It’s not just about the source of protein in your diet; it’s the quantity.

By cutting out these significantly high protein sources in the diet, you are giving your kidneys a break from dealing with a huge incoming protein load!

Protein Content of High Protein Foods

Here are two tables that outline the standard protein amounts for some foods that are high in protein. Tables are separated into animal-based foods and plant-based food categories.

High Protein Animal Products

Food	Protein in grams, per 100 gram prepared serving, (unless otherwise noted)
Eggs	12.4
Egg whites	10.7
Cow’s Milk (2%)	8.0 (in 8 ounces)
Cottage Cheese	11.0
Greek Yogurt	10.3
Cheddar Cheese	23.3
T-bone Beef Steak	27.3
Lamb	27.6
Pork Loin	25.6
Chicken Breast	32.1
Turkey Breast	30.1
Salmon	24.6
Tuna (canned)	19.0
Shrimp	24.0

High Protein Plant Sources

Food	Grams of protein per 100 gram prepared serving (unless otherwise noted)
Soy Milk	8.0 (in 8 ounces)
Black Beans	8.9
Pinto Beans	9.0
Lentils	9.0
Tofu	10.9
Edamame	11.9
Tempeh	19.9
Quinoa	4.4
Almonds	20.4
Pumpkin Seeds	29.8
Peanuts	24.4
Peanut Butter	22.5
Chia Seeds	16.5
Hemp Seeds	31.6
Flax Seeds	18.3

Nutritional supplements for a low protein diet

There are some situations in which supplements may be helpful for a low protein diet. It is important to get physician approval before starting any supplement.

Ketoanalogues

Some studies have shown that adding ketoanalogues to a low or very low protein diet may help delay dialysis. 

Adding ketoanalogues can be a beneficial way to get enough protein without the uremic wastes that come from dietary protein.

Learn more about ketoanalogues here.

Multivitamin

While food should always come first, many people with a low protein diet can benefit from a multivitamin that can help cover nutritional deficiencies.

A B-complex may be a suitable multivitamin for a low protein diet. We have some suggestions in our online dispensary here.*

Some of the common multivitamins for kidney health include ProRenal, Nephrovite, Dialyvite, or Renavite.

Discuss any and all supplements before starting with your doctor and dietitian as they may be able to order it for you.

Low protein diet sample menu

Here is an example of a day of a low protein diet for kidney disease. 

Breakfast: Cream of wheat with chia seeds, fresh/frozen berries, and maple syrup

Snack: Apple and popcorn

Lunch: Veggie wrap with avocado, lettuce, sprouts, red onion, cucumber, carrots, and hummus and a side of chips and corn salsa

Snack: Fruit and veggie smoothie

Dinner: Grilled, marinated Portobello mushroom with sauteed green beans, rice, and a side salad with olive oil and balsamic vinegar

Snack: Frozen grapes

Tips for switching to a low protein diet

Chickpeas instead of chicken is a great budget-friendly swap! And honestly, you haven’t lived until you’ve tried “pulled pork” jack fruit.

Here are a few ideas to inspire you.

Try swapping out ground beef with lentils. You’ll cut the protein amount in less than half.

Whole wheat pasta is great, but don’t forget it has protein, too. Try using spaghetti squash to lower the protein content of your meal.

Did you know that chicken has 26 grams of protein for a 3-ounce portion?

Try out some tofu for a big protein-saving trick.

Tracking a low protein diet

Tracking your food can be a great way to give you insight into your nutrition guidelines. A dietitian can help you decode your diet and make sure you’re in the guidelines to keep your kidneys safe and healthy.

One of my favorite trackers is Cronometer*. You can use the free tool, but I think the real info is in the paid version. It will tell you so much more and you can set goals when working with your dietitian.

When tracking, you’ll want to be as specific as possible. It can get very tedious, but when you use a system like Cronometer* you can set up some of your most common meals and re-use them for quick entries.

Be sure to compare your food journal with your lab test results. The test results can show you more details about your progress.

When to get professional help

To find out if you should or should not be on a low protein diet, it’s important to have a comprehensive nutrition assessment with a renal dietitian. 

It is highly recommended you work with a dietitian when restricting anything in your diet or are managing a health condition like chronic kidney disease.

A low protein diet comes with risks, so trying it by yourself is not recommended.

Work with your healthcare provider to get the support you need and lower the risks of not getting enough nutrition.

Always inform your nephrologist about your goals when it comes to your health. And always speak up for yourself and your health!

Summary

A low protein or very low protein diet can be a good way to save your kidney function and stay away from dialysis for as long as possible.

With less protein comes more fat in the diet. Make sure that it still comes from healthy sources and not processed foods.

To follow a low protein diet in the safest and most beneficial way possible, work with a dietitian. Find a dietitian that specializes in renal nutrition!