Dietary Protein Intake and Bone Across Stages of Chronic Kidney Disease

Elizabeth R Stremke, Annabel Biruete, Kathleen M Hill Gallant

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


PURPOSE OF REVIEW: This review aims to summarize the current evidence on the effect of very-low-, low-, and high-protein diets on outcomes related to chronic kidney disease-mineral and bone disorder (CKD-MBD) and bone health in patients with CKD.

RECENT FINDINGS: Dietary protein restriction in the form of low- and very-low-protein diets have been used to slow down the progression of CKD. These diets can be supplemented with alpha-keto acid (KA) analogues of amino acids. Observational and randomized controlled trials have shown improvements in biochemical markers of CKD-MBD, including reductions in phosphorus, parathyroid hormone, and fibroblast growth factor-23. However, few studies have assessed changes in bone quantity and quality. Furthermore, studies assessing the effects of high-protein diets on CKD-MBD are scarce. Importantly, very-low- and low-protein diets supplemented with KA provide supplemental calcium in amounts that surpass current dietary recommendations, but to date there are no studies on calcium balance with KA. Current evidence suggests that dietary protein restriction in CKD may slow disease progression, which may subsequently benefit CKD-MBD and bone health outcomes. However, prospective randomized controlled trials assessing the effects of modulating dietary protein and supplementing with KA on all aspects of CKD-MBD and particularly bone health are needed.

Original languageEnglish (US)
Pages (from-to)247-253
Number of pages7
JournalCurrent Osteoporosis Reports
Issue number3
StatePublished - Jun 1 2020

Bibliographical note

Funding Information:
This publication was made possible, in part, with salary support to E.R.S. from the Indiana Clinical and Translational Sciences Institute funded, in part, by Award Number TL1TR002531 from the National Institutes of Health (NIH), National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. A.B. was supported by the NIH T32AR065971. K.M.H.G. was supported, in part, by NIH K01DK102864.

Publisher Copyright:
© 2020, Springer Science+Business Media, LLC, part of Springer Nature.


  • Alpha-keto acid analogue supplementation
  • Chronic kidney disease-mineral bone disorder
  • Low protein diets
  • Nutrition

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Review


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