Beyond quantity, the type of dietary protein may be important
to renal outcomes. High-biologic value proteins, which include
lean sources of fish, poultry, eggs, soy and legumes, should make up
between 50% and 75% of the protein intake (6). Diets that emphasize
plant sources of protein (soy, legumes and nuts) may be higher
in potassium and phosphorus. In the Dietary Approaches to Stop
Hypertension (DASH) trials, despite a relatively high protein intake
(1.4 g/kg BW/day), blood pressure was significantly reduced by the
intake of mainly vegetable sources of protein (whole grains, low-fat
dairy products) along with fish and chicken. The DASH diet trials
were not the only studies to demonstrate that there may be some
benefit to limiting red meat (24). In the Nurses Health Study, the
risk for end stage renal disease was greater in women who had
higher intakes of animal meat (24). Therefore, in people within
stages 1 to 2 CKD, employing a patterned approach to intake, such
as the DASH diet, may be beneficial in terms of promoting
appropriate types of proteins and carbohydrates and ultimately
may affect blood pressure, glycemia and proteinuria. A DASH
pattern can be continued until such time as limitations in potassium
or phosphorus intake are required or until the GFR falls below
30 mL/min/1.73m2
. The practical implementation of achieving a
protein-controlled diet through nutrition therapy requires specific
guidance by healthcare professionals and the avoidance of the
word restriction. Specific guidance related to achieving the RDA of
0.8 g/kg BW/day with a maximum of 1.3 g/kg BW/day would be
beneficial, especially for those with a GFR