A Systematic Review of Renal Health in Healthy Individuals Associated with Protein Intake above the US Recommended Daily Allowance in Randomized Controlled Trials and Observational Studies

• Published in: Advances in nutrition (Bethesda, Md.) Vol. 9; no. 4; pp. 404 - 418
• Main Authors: Van Elswyk, Mary E, Weatherford, Charli A, McNeill, Shalene H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2018; Oxford University Press
• Subjects: Adult; Animals; Biomarkers - blood; Blood Pressure; Cross-Sectional Studies; Dietary Proteins - administration & dosage; Energy Intake; Female; Glomerular Filtration Barrier - physiopathology; glomerular filtration rate; Humans; kidney; Kidney Diseases - blood; Kidney Diseases - epidemiology; Kidney Diseases - physiopathology; Male; Middle Aged; Observational Studies as Topic; Plant Proteins - administration & dosage; protein intake; Proteinuria; Randomized Controlled Trials as Topic; Recommended Dietary Allowances; renal; Review; eGFR; blood pressure; OBS; RCT; protein intake; AMDR; glomerular filtration rate; LCD; DASH; AER; renal; kidney; GFR; OmniHeart; WNL; UL
• ISSN: 2161-8313; 2156-5376
• DOI: 10.1093/advances/nmy026

A systematic review was used to identify randomized controlled trials (RCTs) and observational epidemiologic studies (OBSs) that examined protein intake consistent with either the US RDA (0.8 g/kg or 10–15% of energy) or a higher protein intake (≥20% but <35% of energy or ≥10% higher than a comparison intake) and reported measures of kidney function. Studies (n = 26) of healthy, free-living adults (>18 y old) with or without metabolic disease risk factors were included. Studies of subjects with overt disease, such as chronic kidney, end-stage renal disease, cancer, or organ transplant, were excluded. The most commonly reported variable was glomerular filtration rate (GFR), with 13 RCTs comparing GFRs obtained with normal and higher protein intakes. Most (n = 8), but not all (n = 5), RCTs reported significantly higher GFRs in response to increased protein intake, and all rates were consistent with normal kidney function in healthy adults. The evidence from the current review is limited and inconsistent with regard to the role of protein intake and the risk of kidney stones. Increased protein intake had little or no effect on blood markers of kidney function. Evidence reported here suggests that protein intake above the US RDA has no adverse effect on blood pressure. All included studies were of moderate to high risk of bias and, with the exception of 2 included cohorts, were limited in duration (i.e. <6 mo). Data in the current review are insufficient to determine if increased protein intake from a particular source, i.e., plant or animal, influences kidney health outcomes. These data further indicate that, at least in the short term, higher protein intake within the range of recommended intakes for protein is consistent with normal kidney function in healthy individuals.