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A common question that people diagnosed with CKD have is “how much protein should I be eating?” Most people know from googling or talking to their doctor that they need to be eating a low protein diet, but they are not sure exactly what that means.
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There are published guidelines for how much protein people with CKD should consume, so the amount of protein that people should be consuming is not a secret. Maybe you found these guidelines already, but were still confused about how to calculate the amounts, which is why we created this CKD Protein Calculator!
What do the guidelines say about protein and calories for CKD?
According to the KDOQI Nutrition Guidelines:
In adults with CKD 3-5 who are metabolically stable, we recommend, under close clinical supervision, protein restriction with or without keto acid analogs, to reduce risk for end-stage kidney disease (ESKD)/death and improve quality of life a low-protein diet providing 0.55–0.60 g dietary protein/kg body weight/day, or a very low-protein diet providing 0.28–0.43 g dietary protein/kg body weight/day with additional keto acid/amino acid analogs to meet protein requirements (0.55–0.60 g/kg body weight/day)
Or if you have diabetes:
In the adult with CKD 3-5 and who has diabetes, it is reasonable to prescribe, under close clinical supervision, a dietary protein intake of 0.6-0.8 g/kg body weight per day to maintain a stable nutritional status and optimize glycemic control.
The calorie needs recommendations are the same for everyone with kidney disease:
In adults with CKD 1-5D (1C) or posttransplantation who are metabolically stable, we recommend prescribing an energy intake of 25-35 kcal/kg body weight per day based on age, sex, level of physical activity, body composition, weight status goals, CKD stage, and concurrent illness or presence of inflammation to maintain normal nutritional status.
There is also an additional set of guidelines known as the KDIGO Guidelines for CKD Evaluation and Management. Within those guidelines, they say:
We suggest maintaining a protein intake of 0.8 g/kg body weight per day in adults with CKD G3-G5.
Our CKD Protein Calculator can do all of this math for you (plus calculate calories!)….but first you need to understand how to interpret the guidelines better.
Who should not follow a low protein diet with CKD?
These recommendations are intended to individuals who are metabolically stable. If you are not metabolically stable, following a lower protein diet could be harmful. Examples of conditions that would make you not metabolically stable include (but are not limited to):
- Someone with an active inflammatory or infectious disease
- Someone with poorly controlled diabetes
- Someone who has had a recent hospitalization
- Someone on immunosuppressive medications
- Someone experiencing unintended weight loss
It is always best to consult with your doctor or dietitian to determine if lowering your protein intake would be beneficial for your condition.
Additionally, these protein targets are intended for adults with CKD and not children. Children are growing and may have higher protein needs.
These protein targets are also focused on people with Chronic Kidney Disease stages 3-5 who are NOT on dialysis. If you are on dialysis, your protein needs are likely much higher.
What weight is used to calculate protein and calorie needs for CKD?
For the vast majority of people with CKD, these guidelines do not intend for your protein or calorie needs to be based on your actual body weight. I repeat: you probably will not use your actual body weight in the CKD protein calculator. But if you read through the guidelines, they also do not explicitly state what body weight to use, and in fact, make a point of stating that dietitians should use their clinical judgement when determining what weight to use when determining nutrient needs.
Historically, many dietitians and physicians used “Ideal Body Weight” to determine the nutrient needs for patients. Many years ago, the Metropolitan Life Insurance company analyzed data on what weights were associated with the lowest risk of death. The results referred to these weights as “Ideal Body Weight”.
Another way that some people determine “Ideal Body Weight” is using the Hamwi method. For women, this starts at 100 lbs if you are 5 feet tall and adds 5 lbs for each additional inch of height. For example, a woman who is 5’6” would have an ideal body weight of 130lbs. For men, it starts at 106lbs for 5 feet tall and adds 6lb for each additional inch of height. Some people also make adjustments for frame size (adding 10% for people with a large frame and subtracting 10% for people with a small frame).
Neither of the methods for calculating Ideal Body Weight have been validated for people with CKD.
Some other methods of determining appropriate body weight may include:
- “Standard Body Weight” – this method looks at the average 50th percentile weights for men and women based on their age, height, and body frame. The source of the data is the NHANES II data. This method has not been validated in people with CKD.
- “Desirably Body Weight” – this weight is based on studies showing that certain body mass indexes are associated with lower mortality in people on dialysis. Again, this has not been validated in people with CKD.
- “Adjusted Body Weight” – this is an equation that takes ideal body weight and adjusts it by 25% of the difference between the standard and actual weight in people who are overweight and obese. For example, if your actual weight is 250lbs, but your ideal weight is 150lbs, you would calculate the difference between those two numbers (100 lbs), multiply that by 25% (100 x 25% = 25 lbs),and then add that to the ideal body weight to get your adjusted weight (150lbs + 25lbs = 175lbs adjusted body weight). Again, this has not been validated in people with CKD.
With so many different ways to determine an appropriate body weight to use in protein and calories calculations, how do you know which one is right?
The best way to determine which one is right for you to use in this CKD Protein Calculator is to consult a dietitian that specializes in chronic kidney disease. You can pick a method above and enter into our calculator to get a rough idea of what your protein and calories needs might be, but I HIGHLY recommend working with a registered dietitian (also, the guidelines literally state that you should be under close clinical supervision when undertaking a low protein diet, so be sure you are consulting your doctor and dietitian before drastically lowering your protein intake). If you end up cutting out too much protein, there can be negative consequences on your health.
How do you calculate protein for CKD?
Use CKD Protein Calculator (plus calories!)
Be sure to consult your healthcare provider on what the appropriate amount of protein and calories is for you and your unique medical situation.
Additional Guidance when Interpreting the Calculator Results
In addition to the quantity of protein, it is also important to focus on the types of protein. The sources of protein in your diet can have a big impact on your kidney health. To learn more about things that can impact your kidney health, sign up for our free newsletter.
Additionally, you’ll notice that the results don’t give you an exact number, but a range. And with calories, that range is pretty wide. Where you fall within these ranges (and possibly even whether you should be outside that range) will depend on a lot of different factors including:
- Your age
- Your activity level
- Whether you are male or female
- Your physical activity level
- Your body composition
- Whether or not you desire to lose or gain weight
- Other illnesses or conditions you may have
- And a lot of other things!
Consulting with a dietitian can help tremendously in figuring out what is right for you and how best to use this CKD Protein Calculator!
