{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T01:55:39Z","timestamp":1783734939690,"version":"3.55.0"},"reference-count":70,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T00:00:00Z","timestamp":1617667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Multi-factors, such as anorexia, activation of renin-angiotensin system, inflammation, and metabolic acidosis, contribute to malnutrition in chronic kidney disease (CKD) patients. Most of these factors, contributing to the progression of malnutrition, worsen as CKD progresses. Protein restriction, used as a treatment for CKD, can reduce the risk of CKD progression, but may worsen the sarcopenia, a syndrome characterized by a progressive and systemic loss of muscle mass and strength. The concomitant rate of sarcopenia is higher in CKD patients than in the general population. Sarcopenia is also associated with mortality risk in CKD patients. Thus, it is important to determine whether protein restriction should be continued or loosened in CKD patients with sarcopenia. We may prioritize protein restriction in CKD patients with a high risk of end-stage kidney disease (ESKD), classified to stage G4 to G5, but may loosen protein restriction in ESKD-low risk CKD stage G3 patients with proteinuria &lt;0.5 g\/day, and rate of eGFR decline &lt;3.0 mL\/min\/1.73 m2\/year. However, the effect of increasing protein intake alone without exercise therapy may be limited in CKD patients with sarcopenia. The combination of exercise therapy and increased protein intake is effective in improving muscle mass and strength in CKD patients with sarcopenia. In the case of loosening protein restriction, it is safe to avoid protein intake of more than 1.5 g\/kgBW\/day. In CKD patients with high risk in ESKD, 0.8 g\/kgBW\/day may be a critical point of protein intake.<\/jats:p>","DOI":"10.3390\/nu13041205","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T06:05:43Z","timestamp":1617689143000},"page":"1205","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Optimal Protein Intake in Pre-Dialysis Chronic Kidney Disease Patients with Sarcopenia: An Overview"],"prefix":"10.3390","volume":"13","author":[{"given":"Yoshitaka","family":"Isaka","sequence":"first","affiliation":[{"name":"Department of Nephrology, Osaka University Graduate School of Medicine, Suita 565-0871, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1038\/sj.ki.5002585","article-title":"A proposed nomenclature and diagnostic criteria for protein\u2013energy wasting in acute and chronic kidney disease","volume":"73","author":"Fouque","year":"2008","journal-title":"Kidney Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1053\/j.jrn.2013.01.001","article-title":"Etiology of the Protein-Energy Wasting Syndrome in Chronic Kidney Disease: A Consensus Statement From the International Society of Renal Nutrition and Metabolism (ISRNM)","volume":"23","author":"Carrero","year":"2013","journal-title":"J. Ren. Nutr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/MNH.0000000000000318","article-title":"Clinical relevance of sarcopenia in chronic kidney disease","volume":"26","author":"Moorthi","year":"2017","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Sabatino, A., Cuppari, L., Stenvinkel, P., Lindholm, B., and Avesani, C.M. (2020). Sarcopenia in chronic kidney disease: What have we learned so far?. J. Nephrol., 1\u201326.","DOI":"10.1007\/s40620-020-00840-y"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1386","DOI":"10.1681\/ASN.V651386","article-title":"Spontaneous dietary protein intake during progression of chronic renal failure","volume":"6","author":"Ikizler","year":"1995","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1038\/sj.ejcn.1601713","article-title":"Influence of renal function on spontaneous dietary intake and on nutritional status of chronic renal insufficiency patients","volume":"57","author":"Duenhas","year":"2003","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.bbadis.2008.07.007","article-title":"Ubiquitin, proteasomes and proteolytic mechanisms activated by kidney disease","volume":"1782","author":"Rajan","year":"2008","journal-title":"Biochim. Biophys. Acta Mol. Basis Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1172\/JCI22324","article-title":"Muscle-specific expression of IGF-1 blocks angiotensin II\u2013induced skeletal muscle wasting","volume":"115","author":"Song","year":"2005","journal-title":"J. Clin. Investig."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1016\/S0140-6736(02)08024-8","article-title":"Relation between use of angiotensin-converting enzyme inhibitors and muscle strength and physical function in older women: An observational study","volume":"359","author":"Onder","year":"2002","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Lin, Y.-L., Chen, S.-Y., Lai, Y.-H., Wang, C.-H., Kuo, C.-H., Liou, H.-H., and Hsu, B.-G. (2019). Angiotensin II receptor blockade is associated with preserved muscle strength in chronic hemodialysis patients. BMC Nephrol., 20.","DOI":"10.1186\/s12882-019-1223-3"},{"key":"ref_11","first-page":"1435","article-title":"Interleukin-8 in chronic renal failure and dialysis patients","volume":"9","author":"Nakanishi","year":"1994","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000327228","article-title":"Recent Insights in Inflammation-Associated Wasting in Patients with Chronic Kidney Disease","volume":"171","author":"Meuwese","year":"2011","journal-title":"Contrib. Nephrol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1093\/ajcn\/82.4.801","article-title":"Inflammation is associated with increased energy expenditure in patients with chronic kidney disease","volume":"82","author":"Utaka","year":"2005","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1046\/j.1523-1755.2000.00158.x","article-title":"Alterations of protein metabolism by metabolic acidosis in children with chronic renal failure","volume":"58","author":"Boirie","year":"2000","journal-title":"Kidney Int."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.1046\/j.1523-1755.2002.00276.x","article-title":"Nutrition in CAPD: Serum bicarbonate and the ubiquitin-proteasome system in muscle","volume":"61","author":"Pickering","year":"2002","journal-title":"Kidney Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1007\/s12603-015-0641-6","article-title":"Malnutrition in very old hospitalized patients: A new etiologic factor of anemia?","volume":"20","author":"Frangos","year":"2016","journal-title":"J. Nutr. Health Aging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"5766","DOI":"10.1210\/jc.2003-030604","article-title":"Low Vitamin D and High Parathyroid Hormone Levels as Determinants of Loss of Muscle Strength and Muscle Mass (Sarcopenia): The Longitudinal Aging Study Amsterdam","volume":"88","author":"Visser","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Saito, A., Hiraki, K., Otobe, Y., Izawa, K.P., Sakurada, T., and Shibagaki, Y. (2020). Relationship between Serum Vitamin D and Leg Strength in Older Adults with Pre-Dialysis Chronic Kidney Disease: A Preliminary Study. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17041433"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Dai, L., Mukai, H., Lindholm, B., Heimb\u00fcrger, O., Barany, P., Stenvinkel, P., and Qureshi, A.R. (2017). Clinical global assessment of nutritional status as predictor of mortality in chronic kidney disease patients. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0186659"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1093\/ajcn\/87.1.150","article-title":"Dietary protein intake is associated with lean mass change in older, community-dwelling adults: The Health, Aging, and Body Composition (Health ABC) Study","volume":"87","author":"Houston","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1093\/ageing\/afq034","article-title":"Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People","volume":"39","author":"Baeyens","year":"2010","journal-title":"Age Ageing"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"101185","DOI":"10.1016\/j.arr.2020.101185","article-title":"Markers of inflammation and their association with muscle strength and mass: A systematic review and meta-analysis","volume":"64","author":"Tuttle","year":"2020","journal-title":"Ageing Res. Rev."},{"key":"ref_23","first-page":"77","article-title":"Effects of acidogenic diet forms on musculoskeletal function","volume":"23","author":"Jehle","year":"2010","journal-title":"J. Nephrol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1093\/ageing\/afs162","article-title":"The association of frailty with serum 25-hydroxyvitamin D and parathyroid hormone levels in older European men","volume":"42","author":"Tajar","year":"2013","journal-title":"Age Ageing"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ishikawa, S., Naito, S., Iimori, S., Takahashi, D., Zeniya, M., Sato, H., Nomura, N., Sohara, E., Okado, T., and Uchida, S. (2018). Loop diuretics are associated with greater risk of sarcopenia in patients with non-dialysis-dependent chronic kidney disease. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192990"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"46369","DOI":"10.1038\/srep46369","article-title":"Loop diuretics affect skeletal myoblast differentiation and exercise-induced muscle hypertrophy","volume":"7","author":"Mandai","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jamda.2013.11.025","article-title":"Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia","volume":"15","author":"Chen","year":"2014","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jamda.2019.12.012","article-title":"Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment","volume":"21","author":"Chen","year":"2020","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Moon, S.J., Kim, T.H., Yoon, S.Y., Chung, J.H., and Hwang, H.-J. (2015). Relationship between Stage of Chronic Kidney Disease and Sarcopenia in Korean Aged 40 Years and Older Using the Korea National Health and Nutrition Examination Surveys (KNHANES IV-2, 3, and V-1, 2), 2008\u20132011. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0130740"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.1093\/ndt\/gfv133","article-title":"Sarcopenia in chronic kidney disease on conservative therapy: Prevalence and association with mortality","volume":"30","author":"Pereira","year":"2015","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"364","DOI":"10.3109\/0886022X.2015.1132173","article-title":"Sarcopenia in patients undergoing maintenance hemodialysis: Incidence rate, risk factors and its effect on survival risk","volume":"38","author":"Ren","year":"2016","journal-title":"Ren. Fail."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1159\/000101827","article-title":"Kidney Function and Sarcopenia in the United States General Population: NHANES III","volume":"27","author":"Foley","year":"2007","journal-title":"Am. J. Nephrol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1053\/j.ajkd.2014.10.016","article-title":"Creatinine Clearance, Walking Speed, and Muscle Atrophy: A Cohort Study","volume":"65","author":"Roshanravan","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.2337\/dc12-1545","article-title":"Creatinine Excretion Rate and Mortality in Type 2 Diabetes and Nephropathy","volume":"36","author":"Sinkeler","year":"2013","journal-title":"Diabetes Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1053\/j.ajkd.2017.01.052","article-title":"Modified Creatinine Index and the Risk of Bone Fracture in Patients Undergoing Hemodialysis: The Q-Cohort Study","volume":"70","author":"Yamada","year":"2017","journal-title":"Am. J. Kidney Dis."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1681\/ASN.2007040422","article-title":"Age Affects Outcomes in Chronic Kidney Disease","volume":"18","author":"Choi","year":"2007","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1053\/j.ajkd.2020.05.006","article-title":"KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update","volume":"76","author":"Ikizler","year":"2020","journal-title":"Am. J. Kidney Dis."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1016\/j.jamda.2013.05.021","article-title":"Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group","volume":"14","author":"Bauer","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1093\/ndt\/gfm576","article-title":"Metabolic effects of two low protein diets in chronic kidney disease stage 4\u20135\u2014A randomized controlled trial","volume":"23","author":"Cianciaruso","year":"2007","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1053\/j.jrn.2006.12.012","article-title":"Effects of a Supplemented Hypoproteic Diet in Chronic Kidney Disease","volume":"17","author":"Mircescu","year":"2007","journal-title":"J. Ren. Nutr."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Yan, B., Su, X., Xu, B., Qiao, X., and Wang, L. (2018). Effect of diet protein restriction on progression of chronic kidney disease: A systematic review and meta-analysis. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206134"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"De Nicola, L., Provenzano, M., Chiodini, P., Borrelli, S., Russo, L., Bellasi, A., Santoro, D., Conte, G., and Minutolo, R. (2017). Epidemiology of low-proteinuric chronic kidney disease in renal clinics. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172241"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.2215\/CJN.08061109","article-title":"Impact of Age and Overt Proteinuria on Outcomes of Stage 3 to 5 Chronic Kidney Disease in a Referred Cohort","volume":"5","author":"Obi","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1007\/s10157-016-1309-1","article-title":"Risk factors for CKD progression in Japanese patients: Findings from the Chronic Kidney Disease Japan Cohort (CKD-JAC) study","volume":"21","author":"Inaguma","year":"2017","journal-title":"Clin. Exp. Nephrol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2518","DOI":"10.1001\/jama.2014.6634","article-title":"Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of End-Stage Renal Disease and Mortality","volume":"311","author":"Coresh","year":"2014","journal-title":"JAMA"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1681\/ASN.2015060687","article-title":"Past Decline Versus Current eGFR and Subsequent ESRD Risk","volume":"27","author":"Kovesdy","year":"2015","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Rughooputh, M.S., Zeng, R., and Yao, Y. (2015). Protein Diet Restriction Slows Chronic Kidney Disease Progression in Non-Diabetic and in Type 1 Diabetic Patients, but Not in Type 2 Diabetic Patients: A Meta-Analysis of Randomized Controlled Trials Using Glomerular Filtration Rate as a Surrogate. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0145505"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1016\/j.jamda.2015.05.021","article-title":"Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"16","author":"Bauer","year":"2015","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1016\/j.jamda.2016.08.009","article-title":"Impacts of High-Protein Oral Nutritional Supplements Among Malnourished Men and Women with Sarcopenia: A Multicenter, Randomized, Double-Blinded, Controlled Trial","volume":"17","author":"Cramer","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.jamda.2012.07.005","article-title":"Protein Supplementation Improves Physical Performance in Frail Elderly People: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"13","author":"Tieland","year":"2012","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"553.e1","DOI":"10.1016\/j.jamda.2017.03.019","article-title":"Interventions for Treating Sarcopenia: A Systematic Review and Meta-Analysis of Randomized Controlled Studies","volume":"18","author":"Yoshimura","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2052","DOI":"10.2215\/CJN.11791113","article-title":"Effects of a Renal Rehabilitation Exercise Program in Patients with CKD: A Randomized, Controlled Trial","volume":"9","author":"Rossi","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1053\/j.ajkd.2014.10.019","article-title":"Progressive Resistance Exercise Training in CKD: A Feasibility Study","volume":"66","author":"Watson","year":"2015","journal-title":"Am. J. Kidney Dis."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1053\/j.ajkd.2003.12.025","article-title":"Resistance training to reduce the malnutrition-inflammation complex syndrome of chronic kidney disease","volume":"43","author":"Castaneda","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"965","DOI":"10.7326\/0003-4819-135-11-200112040-00008","article-title":"Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency","volume":"135","author":"Castaneda","year":"2001","journal-title":"Ann. Intern. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"F1188","DOI":"10.1152\/ajprenal.00012.2018","article-title":"Twelve-week combined resistance and aerobic training confers greater benefits than aerobic training alone in nondialysis CKD","volume":"314","author":"Watson","year":"2018","journal-title":"Am. J. Physiol. Physiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1056\/NEJMoa1614329","article-title":"Single-Nephron Glomerular Filtration Rate in Healthy Adults","volume":"376","author":"Denic","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2838","DOI":"10.1681\/ASN.2017040421","article-title":"Structural and Functional Changes in Human Kidneys with Healthy Aging","volume":"28","author":"Hommos","year":"2017","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_60","first-page":"E921","article-title":"Functional impact of high protein intake on healthy elderly people","volume":"295","author":"Walrand","year":"2008","journal-title":"Am. J. Physiol. Metab."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1053\/j.jrn.2016.11.004","article-title":"Dietary Protein Sources and Risk for Incident Chronic Kidney Disease: Results From the Atherosclerosis Risk in Communities (ARIC) Study","volume":"27","author":"Haring","year":"2017","journal-title":"J. Ren. Nutr."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1681\/ASN.2008060649","article-title":"High Protein Intake Associates with Cardiovascular Events but not with Loss of Renal Function","volume":"20","author":"Halbesma","year":"2009","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"460","DOI":"10.7326\/0003-4819-138-6-200303180-00009","article-title":"The Impact of Protein Intake on Renal Function Decline in Women with Normal Renal Function or Mild Renal Insufficiency","volume":"138","author":"Knight","year":"2003","journal-title":"Ann. Intern. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.clnu.2015.03.016","article-title":"High dietary protein intake is associated with an increased body weight and total death risk","volume":"35","author":"Corella","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1056\/NEJM199403313301301","article-title":"The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease","volume":"330","author":"Klahr","year":"1994","journal-title":"N. Engl. J. Med."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"2426","DOI":"10.1681\/ASN.V10112426","article-title":"Dietary protein restriction and the progression of chronic renal disease: What have all of the results of the MDRD study shown? Modification of Diet in Renal Disease Study group","volume":"10","author":"Levey","year":"1999","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/S1051-2276(04)00135-9","article-title":"Adequate protein dietary restriction in diabetic and nondiabetic patients with chronic renal failure","volume":"14","author":"Meloni","year":"2004","journal-title":"J. Ren. Nutr."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ekir.2017.08.010","article-title":"Association of a Low-Protein Diet with Slower Progression of CKD","volume":"3","author":"Metzger","year":"2018","journal-title":"Kidney Int. Rep."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1002\/jcsm.12264","article-title":"Low-protein diet for conservative management of chronic kidney disease: A systematic review and meta-analysis of controlled trials","volume":"9","author":"Rhee","year":"2017","journal-title":"J. Cachex Sarcopenia Muscle"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1053\/j.ajkd.2009.07.021","article-title":"Effect of a Low Moderate-Protein Diet on Progression of CKD: Follow-up of a Randomized Controlled Trial","volume":"54","author":"Cianciaruso","year":"2009","journal-title":"Am. J. 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