Nutrition therapy for diabetic nephropathy

Human observational studies report no association between protein intakes less than 20% of energy intake and the development of renal disease. With protein intakes greater than 20% of energy intake there is an association between protein with increased albumin excretion rate. Once albuminuria is present, intervention studies suggest a beneficial effect on renal function with a reduction of protein to 0.8 to 1.0 g/kg/d with microalbuminuria and to 0.8 g/kg/d with macroalbuminuria. Restriction of sodium to 2400 mg/d or possibly for some to 2000 mg/d assists in the control of hypertension. In macroalbuminuria, there may be additional benefits in lowering phosphorus intake to 500 to 1000 mg/d. There is no strong evidence to suggest benefit from vegetable or plant proteins over animal protein, but there is evidence for benefit on renal function, glucose, lipids, and blood pressure from weight-maintaining diets meeting guidelines for a healthy diet.