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Войти в исследования JAMA network open · 2026
Low Daily Protein Intake and Risk of Kidney Failure and Mortality in Chronic Kidney Disease.
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Suh Sang Heon, Choi Hong Sang, Kim Chang Seong, Bae Eun Hui, Kim Jayoun, Jung Ji Yong, Jeong Jong Cheol, Lee Kyu-Beck, Oh Kook-Hwan, Ma Seong Kwon, Kim Soo Wan, Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators
Аннотация
IMPORTANCE: While protein restriction is a cornerstone of chronic kidney disease (CKD) management, its long-term benefits on clinical outcomes in Asian populations, who often have lower body mass and muscle reserves, remain unclear.
OBJECTIVE: To investigate the association between daily protein intake (DPI) and the risk of kidney failure requiring replacement therapy (KFRT) and all-cause mortality in patients with non-dialysis-dependent CKD.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Participants with CKD at stages ranging from 1 to predialysis 5 were enrolled between 2011 and 2016 from 9 tertiary hospitals in South Korea. The study observation period ended on January 31, 2024. Data analysis was performed from February 2024 to May 2026.
EXPOSURES: DPI was objectively estimated using 24-hour urinary nitrogen excretion at baseline. The participants were categorized by DPI: less than 0.6, 0.6 to less than 0.8, 0.8 to less than 1.0, 1.0 to less than 1.2, and 1.2 or greater.
MAIN OUTCOMES AND MEASURES: The primary outcome was the onset of KFRT. Secondary outcomes included all-cause mortality and major adverse cardiovascular events (MACEs). Fine-Gray subdistribution hazard models were used to account for the competing risk of death.
RESULTS: A total of 1861 participants (mean [SD] age, 53.7 [12.0] years; 1304 [61.1%] male) were analyzed, with a median (range) follow-up of 9.3 (0.01-12.37) years. The lowest DPI group (<0.6 g/kg/d) was associated with increased risk of KFRT (subdistribution hazard ratio [sHR], 1.42; 95% CI, 1.09-1.85) as well as all-cause mortality (sHR, 2.17; 95% CI, 1.17-4.03), but not MACEs, compared with the highest DPI group (>1.2 g/kg/d). Furthermore, a nonlinear association was observed, where excessively low protein intake was associated with an increased risk of KFRT.
CONCLUSIONS AND RELEVANCE: In this cohort study of 1861 patients with nondialysis CKD, low protein intake was not associated with significant nephroprotection and was associated with a higher risk of KFRT and all-cause mortality. These findings suggest that rigid protein restriction should be balanced with nutritional monitoring to prevent protein-energy wasting, particularly in populations with lower muscle mass, and a more individualized approach to dietary protein management in CKD may be warranted.
OBJECTIVE: To investigate the association between daily protein intake (DPI) and the risk of kidney failure requiring replacement therapy (KFRT) and all-cause mortality in patients with non-dialysis-dependent CKD.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study used data from the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD). Participants with CKD at stages ranging from 1 to predialysis 5 were enrolled between 2011 and 2016 from 9 tertiary hospitals in South Korea. The study observation period ended on January 31, 2024. Data analysis was performed from February 2024 to May 2026.
EXPOSURES: DPI was objectively estimated using 24-hour urinary nitrogen excretion at baseline. The participants were categorized by DPI: less than 0.6, 0.6 to less than 0.8, 0.8 to less than 1.0, 1.0 to less than 1.2, and 1.2 or greater.
MAIN OUTCOMES AND MEASURES: The primary outcome was the onset of KFRT. Secondary outcomes included all-cause mortality and major adverse cardiovascular events (MACEs). Fine-Gray subdistribution hazard models were used to account for the competing risk of death.
RESULTS: A total of 1861 participants (mean [SD] age, 53.7 [12.0] years; 1304 [61.1%] male) were analyzed, with a median (range) follow-up of 9.3 (0.01-12.37) years. The lowest DPI group (<0.6 g/kg/d) was associated with increased risk of KFRT (subdistribution hazard ratio [sHR], 1.42; 95% CI, 1.09-1.85) as well as all-cause mortality (sHR, 2.17; 95% CI, 1.17-4.03), but not MACEs, compared with the highest DPI group (>1.2 g/kg/d). Furthermore, a nonlinear association was observed, where excessively low protein intake was associated with an increased risk of KFRT.
CONCLUSIONS AND RELEVANCE: In this cohort study of 1861 patients with nondialysis CKD, low protein intake was not associated with significant nephroprotection and was associated with a higher risk of KFRT and all-cause mortality. These findings suggest that rigid protein restriction should be balanced with nutritional monitoring to prevent protein-energy wasting, particularly in populations with lower muscle mass, and a more individualized approach to dietary protein management in CKD may be warranted.