{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:47:27Z","timestamp":1792684047132,"version":"4.5.0"},"reference-count":26,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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\u2013dialysis-dependent CKD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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 (&amp;lt;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 (&amp;gt;1.2 g\/kg\/d). Furthermore, a nonlinear association was observed, where excessively low protein intake was associated with an increased risk of KFRT.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.34568","type":"journal-article","created":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:30:44Z","timestamp":1792683044000},"page":"e2634568","source":"Crossref","is-referenced-by-count":0,"title":["Low Daily Protein Intake and Risk of Kidney Failure and Mortality in Chronic Kidney Disease"],"prefix":"10.1001","volume":"9","author":[{"given":"Sang Heon","family":"Suh","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong Sang","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang Seong","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun Hui","family":"Bae","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayoun","family":"Kim","sequence":"additional","affiliation":[{"name":"Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ji Yong","family":"Jung","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea"},{"name":"Gachon University College of Medicine, Incheon, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Cheol","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyu-Beck","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kook-Hwan","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea"},{"name":"Kidney Research Institute, Seoul National University Medical Research Center, Seoul, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seong Kwon","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo Wan","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea"},{"name":"Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young Youl","family":"Hyun","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeong Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho Jun","family":"Chin","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue K","family":"Park","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaeni","family":"Kim","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seung Hyeok","family":"Han","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) Investigators"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tae-Hyun","family":"Yoo","sequence":"additional","affiliation":[{"name":"for the Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD) 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