DIAGNOSTICS AND TECHNIQUES: Edited by Maarten TaalDietary management of chronic kidney disease protein restriction and beyondGoraya, Nimrita,b; Wesson, Donald E.a,bAuthor Information aTexas A&M Health Sciences Center College of Medicine bScott and White Healthcare Departments of Internal Medicine, Temple, Texas, USA Correspondence to Donald E. Wesson, MD, Texas A&M College of Medicine, Scott and White Healthcare, 2401 South 31st St, Temple, TX. 76508, USA. Tel: +1 254 724 2368; fax: +1 254 724 7113; e-mail: [email protected] Current Opinion in Nephrology and Hypertension: November 2012 - Volume 21 - Issue 6 - p 635-640 doi: 10.1097/MNH.0b013e328357a69b Buy Metrics Abstract Purpose of review More kidney protective strategies are needed to reduce the burden of complete kidney failure from chronic kidney disease (CKD). Clinicians sometimes use protein restriction as kidney protection despite its demonstrated lack of effectiveness in the only large-scale study. Small-scale studies support that dietary acid reduction is kidney-protective, including when done with base-inducing foods like fruits and vegetables. We review these studies in light of current kidney-protective recommendations. Recent findings Animal models of CKD show that acid-inducing dietary protein exacerbates and base-inducing protein ameliorates nephropathy progression, and that increased intake of acid-inducing but not base-inducing dietary protein exacerbates progression. Clinical studies show that dietary acid reduction with Na+-based alkali reduces kidney injury and slows nephropathy progression in patients with CKD and reduced glomerular filtration rate (GFR); base-inducing fruits and vegetables reduce kidney injury in patients with reduced GFR; and base-inducing fruits and vegetables improve metabolic acidosis in CKD. Summary Protein type rather than amount might more importantly affect nephropathy progression. Base-inducing foods might be another way to reduce dietary acid, a strategy shown in small studies to slow nephropathy progression. Further studies will determine if CKD patients should be given base-inducing food as part of their management. © 2012 Lippincott Williams & Wilkins, Inc.