Dietary protein intake and plant-dominant diets to mitigate risk of allograft dysfunction progression in kidney transplant recipients

Purpose of review There are limited studies on the benefits of low dietary protein intake (DPI) and plant-dominant diets to delay kidney allograft dysfunction. We evaluate evidence regarding the association or effects of the amount and type of DPI on allograft function. Recent findings There is conflicting evidence regarding the benefits of low DPI and plant-dominant diet including PLADO and PLAFOND on kidney allograft function. Taking the strength of evidence including study design, sample size, and time to follow-up, the proposed amount of DPI to slow the progression of allograft dysfunction, avoid negative nitrogen balance, and skeletal muscle mass loss is 1.0–1.3 g/kg/day during an immediate posttransplant period or when high protein catabolic rate exists. The DPI may be 0.8–1.0 g/kg/day in patients with stable allograft function. Patients with chronic allograft rejection or estimated glomerular filtration rate <25 ml/min may benefit from the DPI of 0.55–0.60 g/kg/day, while those with failed allograft requiring transition to dialysis including incremental (twice-weekly) hemodialysis should consider increasing DPI to 1.0–1.2 g/kg/day. Summary While there is a lack of strong evidence, individualized approaches based on the patient's comorbidities, net state of immunosuppression, and periods posttransplant may guide the appropriate amount and type of DPI to slow allograft dysfunction.