KDOQI Guidelines

The 2020 KDOQI Guideline For Nutrition in CKD.

Guideline 3 Protein and Energy Intake.


Protein Restriction, CKD patients not on dialysis and without diabetes

  • In adults with CKD 3-5 who are metabolically stable, we recommend under close clinical supervision, protein restriction with or without keto acid analogues, to reduce the risk of end stage kidney disease (ESKD)/death (1A) and improve quality of life (QoL)
  • A low protein diet providing 0.55-0.60g dietary protein/Kg body weight/day or
  • A very low protein diet providing 0.28-0.43g dietary protein/Kg/body weight/day with additional keto acid/amino acid analogues to meet protein requirements) 0.55-0.60 g protein/Kg/body weight/day.


  • Low protein diet or very low protein diet supplemented with a keto-analogue

  • Low protein diet (LPD) or very low protein diet + keto-analogue (VLPD + KA) are both considerations
  • Protein restriction plus KA supplementation (page S45): For adults with CKD without diabetes, not receiving dialysis, with an eGFR <20 ml/min/1.73m2, a VLPD providing 0.28-0.43 g protein/Kg BW day with the addition of KAs to meet protein requirements may be recommended.
  • A VLPD supplemented with KAs could help preserve kidney function in patients with CKD 3-5 (Page S46)


  • Considerations of metabolically stable

    In the context of these recommendations, metabolically stable indicates:
  • The absence of any active inflammatory or infectious disease.
  • No hospitalization within 2 weeks.
  • Absence of poorly controlled diabetes and consumptive disease such as cancer.


  • Find the full guideline here:
    KDIGO 2020 Nutrition in CKD guideline