{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:05:25Z","timestamp":1791943525688,"version":"4.3.4"},"reference-count":47,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The optimal dietary protein intake (DPI) for patients with chronic kidney disease (CKD) remains uncertain. Long-term, clinical practice data using objective DPI measures are limited, and concerns about nutritional risk persist.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate the association of objectively measured DPI with long-term kidney and clinical outcomes in adults with CKD stages 3 and 4.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study included adults with CKD stages 3 and 4 receiving care in Clalit Health Services, Israel, with index entry from January 1, 2007, through December 31, 2022, and follow-up of up to 15 years. DPI was assessed using 24-hour urinary nitrogen excretion and normalized to adjusted body weight (normalized DPI [nDPI]). Participants were stratified by an nDPI threshold of 1.0 g\/kg\/d (selected using time-dependent receiver operating characteristic analysis). Data were analyzed from August to October 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n nDPI calculated from 24-hour urinary nitrogen excretion, analyzed dichotomously using the 1.0 g\/kg\/d threshold.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was a composite of 50% or more decline in estimated glomerular filtration rate (eGFR), initiation of long-term dialysis, or all-cause mortality. Secondary outcomes included individual components and trajectories of eGFR and albuminuria. Propensity score matching was used to balance baseline characteristics between lower (&amp;lt;1.0 g\/kg\/d) and higher (\u22651.0 g\/kg\/d) nDPI groups. Kidney function was evaluated using mixed-effects models and joint models linking eGFR trajectories with time-to-event outcomes.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 1441 included patients (mean [SD] age, 67.20 [11.26] years; 507 [35.2%] women), 530 were matched (265 per group). During follow-up, the lower-nDPI group had a lower risk of the composite outcome (hazard ratio [HR], 0.77; 95% CI, 0.62-0.97; log-rank\n P<\/jats:italic>\n \u2009=\u2009.03), mainly related to fewer dialysis initiations (HR, 0.65; 95% CI, 0.42-0.99). In adjusted Cox models, low nDPI remained associated with lower composite risk (HR, 0.75; 95% CI, 0.60-0.93). Longitudinal models showed no significant between-group differences in eGFR or albuminuria slopes; eGFR decline was numerically slower in the low-nDPI group (slope difference, 0.152 mL\/min\/1.73 m\n 2<\/jats:sup>\n \/y). No differences in nutritional markers were observed.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this retrospective cohort study of adults with CKD stages 3 and 4, lower nDPI (&amp;lt;1.0 g\/kg\/d) was associated with lower dialysis risk without nutritional harm. These findings support moderate protein restriction with routine DPI monitoring in CKD care.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.9575","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:01:02Z","timestamp":1777388462000},"page":"e269575","source":"Crossref","is-referenced-by-count":6,"title":["Protein Intake and Kidney Outcomes in Nondialysis Chronic Kidney Disease Over 15 Years"],"prefix":"10.1001","volume":"9","author":[{"given":"Ilia","family":"Beberashvili","sequence":"first","affiliation":[{"name":"Nephrology Division, Yitzhak Shamir Medical Center, Zerifin, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuvia","family":"Baevsky","sequence":"additional","affiliation":[{"name":"Clalit Health Services, The Central District, Rishon Le Tzion, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Shmuel","sequence":"additional","affiliation":[{"name":"Clalit 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