Protein intake in patients with renal failure: Comments on the current NKF-DOQI guidelines for nutrition in chronic renal failure

The National Kidney Foundation Clinical Practice Dialysis Outcomes Quality Initiative (DOQI) guidelines recently recommended dietary protein intake for patients with chronic renal failure as follows: predialysis patients should receive 0.60 g/kg/ day of protein and increase intake to 0.75 g/kg/day for subjects who cannot follow such a diet. For stable maintenance hemodialysis patients, the recommended protein intake is 1.2 g/kg/day, and for chronic peritoneal dialysis patients, 1.2-1.3 g/kg/day. We differ with these recommendations and believe that a dietary protein intake of 0.8 g/kg/day is appropriate for the predialysis population; an intake of 0.9-1.0 g/kg/day and 1.0-1.1 g/kg/day for maintenance hemodialysis patients and peritoneal dialysis patients, respectively, should be adequate. The rationale and the evidence supporting our arguments are outlined and discussed.