The Role of Low-Protein and Very-Low-Protein Diets in the Nutritional Management of Chronic Kidney Disease and Dialysis: A Comprehensive Review

Abstract

Background: Limiting protein intake remains a fundamental approach in the management of chronic kidney disease (CKD), intended to lessen renal stress and metabolic disturbances. Nonetheless, achieving an appropriate balance between minimizing disease progression and avoiding malnutrition continues to be challenging, particularly in dialysis patients. Objectives: To evaluate why and how low-protein diets (LPD) and very-low-protein diets (VLPD) influence renal outcomes, nutritional status, and overall safety in CKD and dialysis populations. Methods: The review covers the last decade (2014–2025) of 60 peer-reviewed clinical and review studies was conducted, comparing outcomes of LPD/VLPD interventions with varying protein targets, supplementation strategies, and patient populations. Similarities and differences among study results were identified and thematically analyzed. Results: Most studies demonstrated that well-monitored LPD/VLPD regimens, particularly when supplemented with ketoanalogues or emphasizing plant-based proteins, slowed CKD progression and delayed dialysis initiation by approximately 6-12 months. Several studies also reported improvements in serum urea, creatinine, and albumin levels, indicating preserved nutritional status. Under dietitian supervision, Adequate caloric intake, individualized monitoring, and supplementation were key to preventing protein-energy wasting. Conclusion: Low-protein diets are effective and safe when properly supervised, offering metabolic, clinical, and economic benefits. Individualized, plant-dominant, and supplement-supported approaches should be integrated into CKD nutrition care to delay dialysis and maintain patient well-being.