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