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Draft: not yet reviewed by a clinician

Use this page to prepare questions for your care team. It does not replace their advice. Your own targets and doses come from your nephrologist, diabetes team and renal dietitian.

Protein

In short

Protein builds and repairs muscle. Its waste (urea) is cleared by the kidneys, so before dialysis eating a lot of protein makes failing kidneys work harder. Eating too little is also harmful: it causes muscle loss, and with insulin it raises the risk of lows. With diabetes, aim for about 0.8 g per kg a day before dialysis and 1.0–1.2 g per kg on dialysis, and avoid more than 1.3 g per kg (KDIGO 2024; KDIGO 2022; ADA 2026 §11).

Your numbers

Starting points, not your prescription

These numbers are typical starting points from guidelines. Your nephrologist, diabetes team and renal dietitian set your own numbers from your blood tests, urine output and medicines, and change them as your labs change. If your lab report or your team says something different, they win.

Per kg a day For 60 kg For 70 kg For 80 kg
Stages 1–2 0.8 (the app allows up to 1.0) 48–60 g 56–70 g 64–80 g
Stages 3–5 with diabetes, no dialysis 0.8 about 48 g about 56 g about 64 g
Hemodialysis or peritoneal dialysis 1.0–1.2 60–72 g 70–84 g 80–96 g
Avoid more than 1.3 78 g 91 g 104 g
  • With diabetes, not below 0.8 g/kg before dialysis. KDIGO 2024 (recommendation 3.3.1.1), KDIGO 2022 (recommendation 3.1.1) and ADA 2026 (recommendation 11.3) all say 0.8. ADA adds that going lower "is not recommended" with diabetes because it "does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline" (ADA 2026 §11). KDOQI 2020 statement 3.0.2 allows 0.6–0.8 g/kg only "under close clinical supervision" in people who are metabolically stable, which excludes poorly controlled diabetes (KDOQI 2020). The app and this handbook therefore use 0.8 (design note 05); your dietitian may set a different number.
  • On dialysis protein goes up to 1.0–1.2 g/kg (KDOQI 2020 statements 3.0.3–3.0.4; ADA 2026 recommendation 11.3), often the upper end on peritoneal dialysis, because protein is lost into the dialysis fluid (KDIGO 2022, practice point 3.1.2).
  • Too much: more than 1.3 g/kg a day is linked to faster loss of kidney function, more albumin in the urine and heart deaths (KDIGO 2024, practice point 3.3.1.1; ADA 2026 §11).
  • Too little: below 0.6 g/kg risks malnutrition and lows (KDOQI 2020; KDIGO 2022).
  • Older adults who are frail or losing muscle may need more protein and calories, not less (KDIGO 2024, practice point 3.3.1.5).
  • Children with CKD should not have protein restricted; their kidney team sets it for growth (KDIGO 2024, practice point 3.3.1.4). In pregnancy, needs change too: ask your specialist team (Sex, fertility and pregnancy).
  • "Per kg" means per kg of a reference weight your team chooses, not always what the scale says. The app uses your weight unless you are above or below the healthy BMI range for your height, and tells you which weight it used (Targets and warnings).

What a portion looks like

A 3-oz cooked portion of meat or fish is about the size of a deck of cards and gives about 17–27 g of protein. Each protein brings some potassium and phosphorus with it:

Food Portion Protein Potassium Phosphorus
Chicken breast, roasted 3 oz 27 g 220 mg 196 mg
Turkey breast, roasted (not deli) 3 oz 26 g 212 mg 196 mg
Pork loin chop, broiled 3 oz 23 g 303 mg 194 mg
Ground beef, 90 % lean 3 oz 22 g 283 mg 172 mg
Cod, baked 3 oz 19 g 207 mg 117 mg
Tuna, light, canned in water, drained 3 oz 17 g 152 mg 118 mg
Egg whites 2 large 7.2 g 108 mg 10 mg
Egg, whole 1 large 6.3 g 69 mg 99 mg
Tofu, firm ¼ block (about 3 oz) 7.3 g 120 mg 98 mg
Black beans, cooked ½ cup 7.6 g 305 mg 120 mg (plant, less absorbed)
Milk, 2 % fat 1 cup 8.1 g 342 mg 224 mg
White rice, cooked ½ cup 2.1 g 28 mg 34 mg
White bread 1 slice 2.6 g 37 mg 28 mg

From the app's USDA-based food list (USDA FoodData Central; Food lists). Egg whites, chicken, turkey and fish give the most protein for the least phosphorus. Canned tuna has 210 mg sodium per 3 oz, so rinse it.

Plant protein counts. KDIGO advises a diet with more plant foods than animal foods and fewer ultra-processed foods (KDIGO 2024, practice point 3.3.1). Beans and tofu fit if your potassium and phosphate allow; their phosphorus is less absorbed than the phosphorus in meat (Phosphorus).

What to do

  • Ask your team which protein target and which weight to use, and enter it in the app.
  • Spread protein over the day: some at breakfast, lunch and dinner.
  • Before dialysis, keep meat to about 2 oz at lunch and dinner for a 70 kg adult (see the sample menus); on dialysis, 3 oz or more.
  • Use egg whites when you need protein with little phosphorus.
  • If you are losing weight or not hungry, tell your team: do not cut protein further (Eating enough).
  • When you shrink a meat portion to fit, 1 oz less chicken saves about 9 g of protein and 65 mg of phosphorus.
  • Skip protein powders, bars and creatine unless your kidney team approves them: NKF lists creatine among supplements to avoid with kidney disease (NKF; Supplements).

Examples

  • Stage 4, 70 kg, with diabetes: about 56 g a day: an egg and toast at breakfast, a sandwich with 1½ oz of turkey at lunch, 2 oz of chicken with rice at dinner, and bread, rice and snacks for the rest. See the stage 4–5 menu.
  • Hemodialysis, 70 kg: 70–84 g a day: add egg whites at breakfast and 3 oz or more of meat or fish at lunch and dinner. See the hemodialysis menu.
  • Appetite falls on dialysis: if food alone does not meet your needs, KDOQI suggests trying oral nutrition supplements for at least 3 months; your dietitian chooses one that fits your potassium, phosphorus and fluid (KDOQI 2020, statement 4.1.1).

In the app

The app suggests a protein range from your stage and weight and judges protein on your weekly average, so one big or small day does not matter. Single foods with more than 25 g of protein in a serving show a "high" note as a portion reminder (architecture contract). See Targets and warnings.

Ask your care team

  1. What is my protein target in grams, and which weight did you use?
  2. Should my protein change now that my kidney function has changed, or now that I am on dialysis?
  3. Is plant protein (beans, tofu, nuts) OK for me, given potassium and phosphorus?
  4. I am older or losing muscle: should my target be higher?
  5. If I cannot eat enough, which nutrition drink would you suggest?

Get help now if…

Call your care team

You are losing weight without trying, have no appetite for more than a few days, or cannot eat for a day or two. With insulin, eating much less also raises the risk of lows: follow your sick-day plan. For urgent symptoms, see Get help now.

Sources

Not yet reviewed by a clinician. Facts and sources last checked 2026-10-06.