Protein consumption and personalised nutrition in CKD: a comprehensive review

Chronic kidney disease (CKD) poses a global health challenge, with dietary protein intake being a key factor in disease management. This review synthesises evidence on the impact of different protein intake strategies, including low-protein diet (LPD), very-low-protein diet (VLPD), high-protein diet (HPD) and plant-based diet (PBD), on CKD progression and patient outcomes. The review explores personalised nutrition strategies and identifies gaps in the literature. A systematic search of PubMed, Cochrane Library, Web of Science and Scopus was conducted, covering studies published from 1982 to 2024, including randomised controlled trials (RCT), observational studies and meta-analyses involving adult patients with CKD. The findings suggest that LPD and VLPD may slow CKD progression, particularly when supplemented with ketoanalogues, but adherence and long-term benefits remain uncertain. PBD are associated with reduced renal burden and improved metabolic health, although achieving adequate protein intake from plant sources requires careful planning. HPD, particularly those rich in animal protein, may exacerbate CKD progression, although recent research indicates that higher protein intake may benefit specific populations, such as older adults with mild-to-moderate CKD. In conclusion, managing protein intake in CKD is complex and necessitates a personalised approach. While LPD and PBD offer potential benefits, their long-term success is contingent upon patient adherence, individualised dietary management and further research into their sustained effects. Future research should focus on long-term RCT and the development of personalised nutrition strategies incorporating emerging technologies and multidisciplinary care to optimise CKD management.