Kidney Week

Abstract: SA-PO0882

Protein Intake Below 0.6 g/kg/day and Higher Mortality Without Kidney Benefit in Patients with CKD: A 24-Hour Urine-Based Cohort Study

Session Information

• Health Maintenance, Nutrition, and Metabolism
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Health Maintenance, Nutrition, and Metabolism

• 1500 Health Maintenance, Nutrition, and Metabolism

Authors

• Yamada, Takayuki, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Takayuki Yamada, MD

• Inoue, Kosuke, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Kosuke Inoue

• Aoi, Tetsuro, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Tetsuro Aoi

• Okada, Kenta, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Kenta Okada

• Nonaka, Yumi, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Yumi Nonaka, MD

• Obayashi, Yuki, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Yuki Obayashi

• Sunahara, Yasuto, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Yasuto Sunahara, MD

• Obi, Yoshitsugu, University of Mississippi Medical Center Holmes County, Lexington, Mississippi, United States

Yoshitsugu Obi, MD, PhD, FASN

• Kado, Hiroshi, Hatta Medical Clinic, Kyoto, Japan

Hiroshi Kado, MD, PhD

• Hatta, Tsuguru, Hatta Medical Clinic, Kyoto, Japan

Tsuguru Hatta, PhD

• Ida, Tomoharu, Omihachiman Shiritsu Sogo Iryo Center, Omihachiman, Shiga Prefecture, Japan

Tomoharu Ida, DrMed

• Segawa, Hiroyoshi, Hirose Mirai Clinic, Miyazaki, Japan

Hiroyoshi Segawa, DrMed, PhD

Background

Protein restriction is recommended in CKD, but excessive restriction may contribute to frailty. Evidence is limited by the heterogeneous methods used to assess protein intake, often relying on dietary records that are subject to inherent bias and inaccuracy. We examined whether serial 24-hour urine-based estimates of protein intake were associated with mortality and kidney outcomes in CKD.

Methods

We performed a retrospective cohort study of patients admitted for CKD education between 10/2006 and 12/2020 with eGFR <60 mL/min/1.73 m2. Protein intake at baseline and at 3 months after CKD education was estimated from 24-hour urine collections and categorized as <0.6, 0.6–0.8, or >0.8 g/kg/day. Category changes were examined, using persistent intake >0.8 g/kg/day as the reference. Outcomes were all-cause mortality and kidney events, defined as doubling of serum creatinine or kidney failure. Associations were assessed using multivariable Cox models for mortality and Fine-Gray models for kidney events.

Results

Among 1,458 patients followed for a median of 58.5 months, 352 deaths and 559 kidney events occurred. Lower protein intake was associated with higher mortality (P for trend=0.009 at Day 1 and 0.015 at 3 months, respectively); compared with >0.8 g/kg/day, Day 1 HRs were 1.65 (1.13–2.40) for <0.6 g/kg/day and 1.26 (0.93–1.71) for 0.6–0.8 g/kg/day. Similar findings were observed at 3 months, with mortality HRs of 1.72 (1.12–2.65) for <0.6 g/kg/day and 1.17 (0.88–1.57) for 0.6–0.8 g/kg/day. In contrast, protein intake was not associated with kidney event risk at Day 1 or 3 months in Fine-Gray models; sHRs were 0.92 (0.70–1.22) and 1.00 (0.70–1.44), respectively. Category-change and spline analyses showed similar patterns, with higher mortality among patients with persistently very low or decreasing protein intake.

Conclusion

Very low protein intake was associated with higher mortality without kidney benefit in CKD.