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

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A low protein diet has become a new standard in the care of chronic kidney disease. However, this diet is not for every kidney patient. In this article, we will cover what a low protein diet is, who it’s appropriate for, who should not follow a low protein diet, how to determine your protein goals, and tips for following a low protein diet from a renal dietitian’s experience and evidenced-based research.

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Normal Protein Guidelines

Before diving into a low protein diet, let’s look at normal protein guidelines for context.

The recommended daily allowance (RDA) for protein for healthy individuals is 0.8 grams protein per kilogram of body weight.

That means a person weighing 200 pounds (90.8 kilograms) should aim for approximately 73 grams of protein per day.

Low Protein Diet Definition

A low protein diet restricts daily protein intake to levels lower than standard nutrition recommendations.

For the past decade or so, researchers have looked at how a low protein diet may be helpful for kidney patients. 

The Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guidelines and The National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative (KDOQI) are the primary guidelines used at this time for kidney nutrition.

The KDIGO guidelines recommend 0.8 g/kg of protein for CKD patients in stages 3–5. They also support a very low protein diet (0.3–0.4 g/kg) with ketoanalogues under close supervision. (1)

The KDOQI guidelines suggest 0.6–0.8 g/kg of protein for stable CKD patients, also requiring medical oversight.

A very-low protein diet of 0.28-0.43 grams protein per kilogram body weight plus ketoanalogues may also be medically appropriate when closely supervised. (2)

Stable CKD Patient Definition

What makes a kidney patient stable and therefore possibly appropriate to follow a low protein diet?

According to KDOQI, a patient is defined as metabolically stable when a patient: (2)

• Has no active inflammatory or infectious diseases
• Has not been hospitalized within two weeks
• Has well-controlled diabetes
• Has well-controlled consumptive diseases (i.e. cancer)
• No antibiotics or immunosuppressive medications (i.e. 
• No significant short-term weight loss

Significant weight loss is defined as weight loss greater than 5% of your weight within the past 6-12 months.

For example, a person that had been weighing 200 pounds for the past few years lost 20 pounds in the past 6 months without trying.

They lost 20 lbs/200 lbs x 100 = 10% weight loss. This would be significant weight loss.

In this example, this person would not be considered metabolically stable.

It’s important to understand this as someone not in a metabolically stable situation would be more at risk for further harm trying to follow a low protein diet.

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.

As mentioned above, KDIGO and KDOQI guidelines recommend a low protein diet in some situations for patients in stages 3-5 CKD not on dialysis.  (1, 2)

Research has also shown that those with diabetes and early stages 1-3 chronic kidney disease may benefit from a low protein diet. (3)

However, the KDIGO guidelines state that those with diabetes be cautious with a low protein diet if blood sugars are uncontrolled. 

If you have both diabetes and kidney disease, it is important to work with a dietitian to have individualized guidance on the best amount of protein for your body.

Who should not follow a low protein diet?

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 a high protein diet of 1.2-1.4 grams per kilogram per day. This is due to the protein losses from dialysis treatments.

A low protein diet is not recommended for a person with cancer. Cancer requires a high protein diet. (4)

If you have been recently hospitalized or have unstable health, a higher protein intake may be necessary.

In these cases, it is especially important to work with a registered dietitian so that you get the right amount of protein for your individual needs.

Benefits of Low Protein Diet

A low protein diet offers several potential benefits for kidney disease patients, including (3. 5);

• Reduced proteinuria (protein in the urine)
• Lower blood urea nitrogen (BUN) levels
• Better cholesterol and lipid levels
• Improved blood sugar control in diabetes
• Lower risk of metabolic acidosis (lower PRAL)
• Reduced oxidative stress and insulin resistance
• Better phosphorus balance
• Potential delay in CKD progression

Additionally, a low protein diet when paired with a low sodium diet has been shown to improve blood pressure. (6)

Risks of Low Protein Diet

While beneficial for some, a low protein diet carries risks, especially if not monitored properly.

These risks can include:

• Unintentional weight loss – Insufficient calories can lead to muscle loss.
• Increased inflammation – Poor nutrition can trigger inflammation, impacting blood sugar control.
• Nutrient deficiencies – Many high-protein foods provide essential nutrients like iron, vitamin B12, and calcium. Restricting protein and not eating enough may lead to anemia, a common CKD complication.

To minimize risks, work with a renal dietitian to ensure balanced nutrition.

Getting Enough Calories on a Low Protein Diet

One of the most important things to do when on a low protein diet for kidney disease is to eat enough calories.

Nutrition guidelines emphasize the importance that kidney patients eat at least 25 – 35 calories per kilogram of body weight. (2)

Fat and carbohydrates are the other macronutrients in our diet. (Although technically, alcohol is considered another.)

Therefore, calories from healthy fats and quality carbohydrates will need to be increased when on a low protein diet.

Calorie Calculator

Use this calculator to get an estimate of 25 – 35 calories per kilogram of body weight.

You can enter weight in either pounds or kilograms and the calculator will do the conversion for you.

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

Low Protein Diet Calculator

Use the calculator below to estimate normal and low protein diet protein goals.

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

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 – most are less than 1 gram protein per ½ cup.
• Vegetables – most are less than 2 grams protein per ½ cup.
• Whole grains – the highest-protein whole grains include wheat berries, spelt, and amaranth at about 5 grams per ½ cup.
• Healthy fats – nuts and seeds can have around 7-10 grams protein per ounce so enjoy in moderation.

Other foods to include in a low protein diet;

• Herbs
• Spices
• Condiments like jam, mayonnaise, mustard, and ketchup
• Coffee and tea
• Sauces and some dips

Healthy Fats

Heart-healthy fats are a must when it comes to a low protein diet. They provide antioxidants, protect against inflammation, and of course provide the calories needed to help stick to a low-protein diet.

Some of my favorite fat sources include;

• Olive oil
• Avocado oil 
• Sesame oil
• Flaxseed oil
• Walnuts
• Pecans
• Macadamia nuts
• Avocado
• Hemp hearts
• Low sodium olives

Foods to Limit on a Low Protein Diet

Foods highest in protein tend to come from animal products. Therefore, a plant-based diet can easily be incorporated into a low protein diet.

By cutting out animal proteins, you are going to eliminate some of the highest protein sources in your diet.

This includes;

• Chicken/poultry
• Fish/shellfish
• Beef
• Lamb
• Game meats

Additionally, high-protein plant foods such as tofu, legumes and beans may need to be limited to smaller portions. 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!

High Protein Foods to Limit

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 Foods

Note: 100 grams is approximately 3.5 ounces.

Food	Protein in grams, per 100 gram prepared serving, (unless otherwise noted)
Eggs	6 grams (1 large whole egg)
Egg whites	11
Cow’s Milk (2%)	8.0 (in 8 ounces)
Cottage Cheese	11
Greek Yogurt	10
Cheddar Cheese	23
T-bone Beef Steak	27
Lamb	28
Pork Loin	26
Chicken Breast	32
Turkey Breast	30
Salmon	25
Tuna (canned)	19
Shrimp	24

High Protein Plant Foods

Food	Grams of Protein (per serving)
Soy Milk	8 (8 ounces)
Black Beans	7 (½ cup cooked)
Pinto Beans	9 (½ cup cooked)
Lentils	9 (½ cup cooked)
Tofu	22 (½ cup firm)
Edamame	18 (1 cup shelled)
Tempeh	34 (1 cup)
Quinoa	8 (1 cup cooked)
Almonds	6 (1 ounce)
Pumpkin Seeds	8 (1 ounce)
Peanuts	7 (1 ounce)
Peanut Butter	7 (2 Tablespoons)
Chia Seeds	5 (1 ounce)
Hemp Seeds	10 (3 Tablespoons)
Flax Seeds (ground)	4 (2 Tablespoons)

Tracking a Low Protein Diet

Tracking your food can be a great way to give you insight into your nutrition guidelines.

One of my favorite trackers is Cronometer*. There is a free and paid plan available. 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.

A dietitian can help you decode your diet and make sure you’re in the guidelines to keep your kidneys safe and healthy.

Supplements for a Low Protein Diet

There are some supplements that may be helpful for a patient following a low protein diet.

Ketoanalogues

Some studies have shown that adding ketoanalogues to a very low protein diet may help in delaying dialysis. (7)

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

Ketoanalogues are the amino acids of proteins but without the uremic toxins the body and kidneys typically deal with. Learn more about ketoanalogues here.

B-Complex or Kidney-Specific Multivitamin

One of the other supplements you may want to look into is a kidney-safe multivitamin.

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

Some of the common multivitamins for kidney health include ProRenal* and Renavite*. Discuss any and all supplements prior to starting with your doctor and dietitian.

Some kidney patients may be approved to take a B-complex vitamin. We have several included in our online supplement shop here. Talk with your doctor or dietitian about which one is best for you.

I do not generally recommend a standard multivitamin. This is because a general multivitamin can include nutrients like potassium and phosphorus that are not helpful to supplement for most kidney patients.

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 ground flax seeds, chia seeds, berries, and maple syrup

Snack: Apple and popcorn

Lunch: Whole wheat 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 with almonds

Low Protein Diet Meal Plan

If you’d like a full 7-days of low protein diet, check out our low protein diet meal plan.

This meal plan includes 7 full days of three meals and three snacks, so you’ll never be hungry.

There is no more than 40 grams of protein per day with no more than 4,000 milligrams of potassium per day.

You’ll get 23 recipes plus a done-for-you grocery list for the full plan.

Tips for Following a Low Protein Diet

Be sure to replace the proteins you are removing in your low-protein diet. As stated before, adding healthy fats and quality carbohydrates will be important to get enough calories and keep you healthy.

Here are a few ideas to inspire you.

Lentils for Ground Beef

Try swapping out ground beef with lentils. You’ll cut the protein amount in more than half, but add a big boost of fiber.

Tofu for Chicken

Did you know that chicken has about 30 grams of protein for a 3-ounce portion? A palm-size amount of chicken is about 3-4 ounces.

Try out some tofu for a big protein-saving trick. The key to using tofu is to marinade for added flavor – just like chicken.

Jackfruit for Pork

Canned or packaged jackfruit is popping up in the deli area of grocery stores more and more. Shredded jackfruit makes for a great pulled pork swap.

Marinade it in your favorite barbeque sauce, add it to the slow cooker or stove stop to soften, and broil to crisp up a little before piling up onto a bun for a vegan pulled pork sandwich.

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. Ask your doctor for a referral to a dietitian, ask your health insurance, or find one through resources like the National Kidney Foundation.

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 diet can be beneficial for individuals with chronic kidney disease (CKD), particularly in stages 4 and 5, as it helps reduce the strain on the kidneys and may slow disease progression. However, it is not recommended for dialysis patients, individuals recovering from illness or hospitalization, kidney patients with uncontrolled blood sugars, those with significant weight loss, or those with high protein needs, such as cancer patients.

People following a low protein diet should aim for 0.6 – 0.8 grams of protein per kilogram of body weight, depending on their CKD stage and medical recommendations.

The focus should be on eating fruits, vegetables, whole grains, and healthy fats while limiting high-protein foods such as meat, while limiting portions of high-protein dairy and legumes. It is also important to work with a renal dietitian to ensure adequate calorie intake and prevent nutrient deficiencies.

For an easy way to follow a low protein diet, check out our Low Protein Meal Plan, which includes simple recipes, a grocery list, and balanced meal ideas to support your kidney health.