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Chronic kidney disease (CKD) is becoming increasingly widespread in the world. Slowing its progression means to prevent uremic complications and improve quality of life of patients. Currently, a low-protein diet (LPD) is one of the tools most used in renal conservative therapy but a possible risk connected to LPD is protein-energy wasting. The aim of this study is evaluate the possible correlation between LPD and malnutrition onset. We enrolled 41 CKD patients, stages IIIb/IV according to K-DIGO guidelines, who followed for 6 weeks a diet with controlled protein intake (recommended dietary allowance 0.7 g per kilogram Ideal Body Weight per day of protein). Our patients showed a significant decrease of serum albumin values after 6 weeks of LDP (T2) compared with baseline values (T0) ( P =0.039), whereas C-reactive protein increased significantly (T0  versus  T2;  P =0.131). From body composition analysis, a significant impairment of fat-free mass percentage at the end of the study was demonstrated (T0  versus  T2;  P =0.0489), probably related to total body water increase. The muscular mass, body cell mass and body cell mass index are significantly decreased after 6 weeks of LDP (T2). The phase angle is significantly reduced at the end of the study compared with basal values (T0  versus  T2;  P =0.0001, and T1  versus  T2;  P =0.0015). This study indicated that LPD slows down the progression of kidney disease but worsens patients' nutritional state.

Is low-protein diet a possible risk factor of malnutrition in chronic kidney disease patients?