Protein Restriction in Chronic Kidney Disease: A Patient-Centred Reappraisal

Dietary protein restriction has long been used in the management of chronic kidney disease (CKD), based largely on physiological reasoning and older clinical studies.Yet its place in current CKD care remains debated, particularly now that several therapies can slow progression and improve clinical outcomes, shifting the question from whether protein intake affects kidney physiology to whether prescribed restriction improves outcomes that patients directly experience.This viewpoint re-examines protein restriction through patient-centered outcomes, including survival, physical function, nutritional status, frailty, and treatment burden. Limits of evidence baseMost trials evaluating protein restriction have relied on surrogate outcomes such as serum creatinine or slope of GFR decline.These biochemical markers, while useful in disease monitoring, do not fully capture or predict outcomes that patients value, including longevity, symptom burden, or physical function.Therefore, interventions adopted in routine care should be judged not only by laboratory changes but also by how patients feel, function, and live.