Journal
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
Volume 31, Issue 8, Pages 1667-1679Publisher
AMER SOC NEPHROLOGY
DOI: 10.1681/ASN.2020010028
Keywords
nutrition; chronic kidney disease; high protein diet; glomerular hyperfiltration; proteinuria
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Funding
- NIH/NIDDK [K23-DK102903, R03-DK114642, R01-DK122767]
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Although high-protein diets continue to be popular for weight loss and type 2 diabetes, evidence suggests that worsening renal function may occur in individuals with-and perhaps without-impaired kidney function. High dietary protein intake can cause intraglomerular hypertension, which may result in kidney hyperfiltration, glomerular injury, and proteinuria. It is possible that long-term high protein intake may lead to de novo CKD. The quality of dietary protein may also play a role in kidney health. Compared with protein from plant sources, animal protein has been associated with an increased risk of ESKD in several observational studies, including the Singapore Chinese Health Study. Potential mediators of kidney damage from animal protein include dietary acid load, phosphate content, gut microbiome dysbiosis, and resultant inflammation. In light of such findings, adopting current dietary approaches that include a high proportion of protein for weight reduction or glycemic control should be considered with care in those at high risk for kidney disease. Given the possibility of residual confounding within some observational studies and the conflicting evidence from previous trials, long-term studies including those with large sample sizes are warranted to better ascertain the effects of high protein intake on kidney health.
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