A 45-Year-Old Man With Type 2 Diabetes, Stage 1 CKD, and High-Protein Diet Use

A 45-year-old man who had been diagnosed with type 2 diabetes was seen for management of diabetes and chronic kidney disease stage 1. There was a background history of stable retinopathy and hypertension, treated with an ACE inhibitor. When the disorder began, he had a BMI of 30 and weighed 210 lbs, but had lost over 100 lbs through self-imposed dietary changes (an Atkins-like high-protein, low-carbohydrate diet). In the subsequent months, he lost 10 lb, there was improvement in his fasting triglycerides (185 to 130 mg/dL), and blood pressure had fallen from 130/80 to 120/78 mmHg. On statins alone, LDL cholesterol was unchanged. His 24-hour urinary albumin increased from 100 to 200 mg, whereas serum creatinine and glomerular filtration rate remained normal (2.0 mg/dL and MDRD-GFR of 98 mL/min/1.73 m²), respectively, indicative of stage-1 chronic kidney disease. Understanding the potential risks of renal damage from prolonged, high-protein intake (and particularly in a diabetic patient), he agreed to change to a 1,500-kcal, low-fat diet with an exercise program based on structured walking. The patient's urine microalbumin was then reduced, which suggests the importance of personalized nutritional intervention in patients with diabetic kidney disease and warrants caution regarding the use of high-protein diets in this group. How would you balance the potential metabolic benefits of a high-protein, low-carbohydrate diet against the renal risks in a patient with diabetic kidney disease?

Diagnosis added by author

• Type 2 diabetes and CKD

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