What are the differences in protein requirements among stages 1 and 2 CKD, stage 3 and 4 CKD, hemodialysis, and peritoneal dialysis patients? What is the rationale for these differences?

Question

What will be an ideal response?

Answer 1

Pre-dialysis (Stages 1-2):
• 0.8-1.4 g/kg
• Rationale: Adequate protein to preserve muscle mass, serum proteins, and kidney function; the current evidence doesn't suggest lowering protein intake at these stages of kidney function

Pre-dialysis (Stages 3-4):
• 0.60-0.75 g/kg;
• Rationale: Adequate protein to preserve muscle mass and serum proteins; due to a lower level of kidney function, this lower protein diet can limit the production of nitrogenous wastes and their effects on the loss of kidney function
HD:
• ≥1.2 g/kg SBW; ≥50% HBV
• Rationale: Loss of protein during dialysis; altered albumin turnover; metabolic acidosis, which increases amino acid degradation; inflammation; and infection
PD:
• ≥1.2-1.3 g/kg SBW; ≥50% HBV
• Rationale: Dialysate protein losses increase by 50-100% to an average of 5-15 g/day; peritonitis increases losses more to about 15-36 g/day

Note: HBV (high biological value) protein is suggested due to its similar amino acid composition to human protein and its increased utilization in the body. This should prevent the increasing nitrogenous load that protein metabolism promotes.