Abstract

Protein intake recommendations for patients with chronic kidney disease (CKD) stages 3–5 without kidney replacement therapy (KRT) remain controversial. This study investigated current practice trends related to the 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) protein guidelines and dietitians’ perspectives on low-protein diets (LPDs) and plant-based diets in CKD. This mixed-methods explanatory sequential study included a secondary analysis of an online survey (N = 87), followed by a conventional content analysis of two virtual focus groups (N = 11). Most survey respondents reported prescribing the KDOQI-recommended protein amounts of 0.55–0.6 g/kg/d in patients without diabetes (65.9%) and 0.6–0.8 g/kg/d in patients with diabetes (81.5%). Use of keto-acid analogs (KAs) was low among survey participants (18.4%). Focus group participants described varied approaches for calculating protein goals but overwhelmingly stressed the importance of individualized care. Key factors influencing recommendations included nutritional status, food preferences, comorbidities, current intake, and knowledge, beliefs, attitudes, and motivations. In summary, most participants recommended LPDs consistent with the KDOQI guidelines; however, KA use was uncommon. Despite differences in decision-making, participants emphasized individualizing protein recommendations to each patient’s unique needs. Given the exploratory nature of this work and the small, self-selected sample, these results provide preliminary insights that warrant further investigation in more diverse samples.

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