I am a 71 year old man almost 16 months out from a cadaveric renal transplant and doing well. I have been exercising for over 10 years, I currently do 30 minutes of calisthenics three times a week and walk on a treadmill for an hour 7 days a week.
I read that protein intake is important for seniors to prevent the normal muscle loss with aging. I found an article recommending that seniors should aim to double the recommended daily protein intake. I started taking a protein powder with my morning decaf (10 grams).
My creatinine bumped up significantly, and the transplant nephrologist recommended stopping it, which I did. My creatinine has come back down, although not all the way. Has anyone else noted a change in kidney function related to protein intake, and what level of protein intake do people aim for?
Thank you!
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Hawk12
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Hi Dr. Hawk. How wonderful that you got a transplant. As you know, I am sure, there are different kinds of protein, and some are harder on the kidney than others. Protein supplements are known for raising creatinine. I would think you would want to be careful with the transplanted kidney and be mindful or a renal diet that does include protein, but maybe more plant based. I am not a certified renal dietician, which is who you should probably check with.
The fact that you are exercising is probably more helpful than the protein supplement. I am stage 4-5 and have been for over 8 years. I have been working with a renal dietician since 2018.In 2021, I was consuming a very..very low protein diet (30 mg or less daily) and mostly plant based, but found I was having muscle wasting. Last year summer, I started a regular exercise program and upped my protein with eggs and a bit of chicken and turkey once in awhile. Feeling much stronger and doing ok.
Thank you Bassetmommer. Good advice! I talked to the renal dietician prior to my transplant, but it would be a good idea to schedule another appointment. I am glad that you are feeling stronger!
1. Having to focus on protein for the reasons you've clearly stated. Many on here have similar issues with that.
2. Getting nutrition advice from a nephrologist as most/all medics are untrained & unqualified in that.
I believe the best way to resolve 1, 2 is to seek advice from a qualified nutritional advisor that specialises in renal. My aversion to dieticians is based on both personal experience and their financial conflict of interest. Can supply details.
Below Ive listed nutritional therapists that qualified from the renowned College of Naturopathic Medicine. The 2nd link includes dieticians if you really prefer them despite my reservations. You'd have to choose your preference(s) based on specialism and/or location e.g. most probably consult online but you may prefer face-face, if you can source.
Most of those Ive listed should be BANT-approved as that's the gold standard, but check.
I am going to answer about dieticians VS nationalists. It is a great question. It all comes down to license vs certification and required education. Dietician needs a graduate degree,,,nutrtionist...... no degree.
This article explains it quite well:
"The word dietitians typically refers to registered dietitians (RDs). Compared with nutritionists, the main difference is that RDs tend to have more education and credentials. Depending on the state in which you practice, you can call yourself a nutritionist without any formal nutrition education, training, licensing or certification, but it’s illegal to call yourself a dietitian without proper credentialing." publichealthdegrees.org/car...
For a dietician: "The recommended order of listed credentials for registered dietitians (RD) or registered dietitian nutritionist (RDN)* is: graduate academic degree, RD or RDN., specialty certifications with the Commission on Dietetic Registration (e.g. CSG, CSO, CSOWM, CSP, CSPCC, CSSD, CSR), licensure designation, other certifications (e.g. CDCES, CNSC)Fellow of the American Dietetic Association (FADA),Fellow of the Academy of Nutrition and Dietetics (FAND)" cdrnet.org/rd-credential-pl...
Nutritionist: "That said, in states that offer this credential instead of a license, uncertified individuals can still provide the services of the profession, so long as they don’t promote themselves with any protected title. Because they’re not being regulated by the board and therefore aren’t held to the established standards, clients should be careful to receive services from uncertified individuals." naturalhealers.com/nutritio...
In other words, you can be a practicing nutritionist with a simple certification or even without any credentialing. I often see nutritionists associated with providing supplements as part of their service.
Thanks for posting this, Bassetmommer, this is a big problem where I live because just about anyone can hang a shingle and call themselves a qualified nutritional advisor. Some people take a 2-year course on Udemy and think they know it all! There isn't nearly enough regulation.
Be careful, get a referral from your doctor to a qualified professional and make sure it is some one credentialed, certified, with experience with Renal Issues. I'm fortunate that my team has a Renal Dietician on board, and I also see a Naturopath.
Also, I wanted to say I also went very low protein (Dr Lee Hull), as you did, and I found it was just to low for me, I was so weak; and I had to add some back to be able to function in my daily life.
Great advice. Too many money grabbing people out there hanging up a shingle..Too many clerks in health food shops giving bad advice and too any on faebook...All of us have a unique set of genes and what works for one does nt work for someone else...Unless you are eating Oleanders.. or antifreeze mose foods and not deadly in small amounts.. even a diabetic can eat some jelly beans on occasion.. but the 3 cups of rice daily is not good...Supplements are so risky..but someone is selling them..and someone gets sucked in..can't g wrong with exercise water and good attitude,,avoid the scams..remember there are 3 tpes of food.. protein.. fats and sugars and all of the are essential.. in general fats assist hormone levels... protein repairs tissue and rebuilds and carbs/sugars keep us alive...all carbs turn into sugars..bread.. rice.. and jelly eans.. our brains need some... make sure your rofessional advice is from a real professional...
Thank you Bassetmommer! Good advice again! 😊 I think that userotc is in Britain, and their situation may be a bit different than in the States. As a retired surgeon, I agree with userotc that most physicians have little education or training in nutrition. The British Association for Nutrition and Lifestyle Medicine seems like a legitimate organization.
I guess that my question is whether protein is harmful to the kidney? The consensus seems to be that it is, and that’s what I’ll get from a dietitian. My creatinine DID go up with increased protein intake, but is that necessarily an indication of harm? I am no expert, but I did a Google search and there ARE studies suggesting that higher protein intake is NOT harmful to the kidneys.
I'm on Peritoneal dialysis for a month and my "team" is saying I need to dramatically increase my protein intake, but at the same time. I want to preserve what's left of my natural kidneys. Are those opposing tasks? I agree, it's very hard to know just from what I can read and my Neph has no idea, and the dietician at the clinic has NO idea about diet for preserving natural kidney function, she ONLY focuses on dialysis, so the only way to know from what I can tell is to see if this high protein diet they have put me on finishes off my natural kidneys in short manner. Then I will know. I was on a low protein diet which helped me postpone dialysis for 3 years, and I probably could've held off even longer but my doc kept saying I wanted to avoid emergency dialysis, so I decided to jump on the PD wagon this past fall.
So you are correct, there's no good answer out there for high protein/low protein. Though it does seem to be the general consensus that high protein is harder on the kidneys. Just no evidence they speed up decline, especially for us PKD folks. Thanks for your response.
Keep in mind that dialysis does remove quite a bit of protein, so we need to restore it. My team recommends 90 g a day, which takes some extra protein sources to meet some days. Yes, it is hard to find reasonably-priced protein with low phosphorous and potassium. We will keep looking. I like the Glucerna butter pecan shakes as an alternative to chocolate... Vanilla gets old, too. My kidney function stayed at 8 since dialysis, and I still urinate normally.
I was told by one nephrologist not to do high protein diet plans as I was trying to find something to lose the weight from prednisone as exercise alone wasn’t getting it. I asked another could I do nutrisystem and he said yes and I’ve felt better. Will be doing my labs next month so will see but I don’t do any supplements of protein
Congratulations on your transplant Hawk12, I am 14 months post transplant ‘live donor’ and I eat a little chicken and eggs twice a week. I feel unwell if I don’t have any meat protein in my diet and I was advised by my transplant team to include some white meat in my diet. I used to be a gym bunny pre transplant and used protein powder’s regularly but was advised to stop taking them by my CKD consultant as they are not good for the kidneys. I personally would never take protein supplements ever again. You should definitely check with your renal dietitian at the clinic you attend. 😊
Thank youFrenchie05. Congratulations to you as well! I was told to stop the protein powder and I have. They DID say that I could increase my protein intake as long as it was real food!
Are you sure there isn't creatine in the protein supplement? Lots of these supplements even add creatine. Like others have said, supplements aren't the best for us. They aren't regulated so you don't even know what is in most of them. From what I've read, eating protein is far better than taking a supplement.
Thank you barbara55109! Creatine was not listed but it did have sucralose which is supposed to be bad for your gut and an “immune enhancing blend” (vitamins C, D, and zinc, which is obviously not something that I should have been taking!
I DO miss it though - it was chocolate and I added it to my decaf - delicious!
According to DaVita: “Since you are on peritoneal dialysis, you need to consume more protein than the average hemodialysis patient because you lose small amounts of protein every time you drain the dialysate from your abdomen”.
I was EXTREMELY fortunate to avoid dialysis prior to my transplant!
Hmmm...since you've received a transplant, you might want to ask the Kidney Transplant community for their feedback. Rising creatinine levels, particularly over time, can indicate many different things, particularly for transplant patients. Or you may want to simply consult with the experts, your transplant center, to put your mind at ease. None of us here can diagnose. As a side note, at my hubby's transplant center, supplements and over-the-counter meds are off the table unless cleared by doctors in coordination with a pharmacist. It's interesting to see how different centers and countries operate! As for my hubby's diet post transplant, he was told to return to a normal, not a renal, diet with its recommended daily allowances with the exception of foods with sugars and carbs because he's diabetic.
Thank you Darlenia! I take no supplements (my Nephrologist had me stop everything when I was diagnosed with renal failure). And I clear any medications with the transplant nephrologists.
The transplant nephrologists ordered an ultrasound of my kidney as well as a transplant PRA and AlloSure test, all of which came back negative for rejection. I was fortunate to receive a six antigen match, but I guess that doesn’t totally prevent rejection.
That's wonderful! You're fortunate that there's no rejection going on. That was my first concern. Rejection can happen incredibly fast - my friend's hubby passed away in days from acute rejection when he took a common medication prescribed by an unaware doctor for an infected toe. I don't have the specifics anymore, but it was quick! Here one day, gone the next. If I remember correctly, I think you might be diabetic? If so, diabetes may be influencing the numbers, since sugars spike so easily with immunosuppressants. However, it generally takes some time for real damage to happen. So, in your case, it could well be nothing. I do think you have many quality years ahead since your match was great. It's nice to live life well. Blessings!
Thank you Darlenia! Wow, that is scary about your friend’s husband! Yes, I am diabetic and I am on prednisone (I really tried to get them to stop it at one year, but they said that I was on a low dose of mycophenalate and wouldn’t stop it). I have managed to lose about 20 lbs or so and that has my A1c in the good range. Hopefully, I can maintain that!
Ron, I was wondering the same thing. I checked the Davita Website, and lists recommended protein SHAKES very low in potassium, phosphorous, and sodium. Recommendations are potassium 200 and below, phos 150 and below, sodium 300 mg and below. I do not yet know about prices. T heir seems to be some cautions about protein powder, so I stay away from those. Davita is a great site for all kidney diet and nutrition recommendations, so check into it.
I see a lot of ads for protein drinks, bars, powders but when I look up the nutrition label they are either high in sodium, potassium or phosphorus or all three. I'm still searching for the holy grail....high protein (20 mg or better), low sodium, low phosphorus, and right now the potassium isn't an issue as I'm low but still when I see 500 mg it's off the list.
What I don't understand is the high sodium in a lot of these. But I'm guessing it's so they are shelf stable. And I should add taste as I've had some really bad tasting protein bars. And cost, these things are expensive. A case of 24 Nepro which meets the criteria is almost $100 and isn't supplied by the center.
Do you all use the powder for smoothies? Do you mix it in other things?
So far I've tried liquacel (yuk!), and Premier protein powder, which is fine in smoothies mixed with non-dairy whipped cream and frozen fruit, but with the amount you need, I find it makes oatmeal taste a bit weird in texture. Not sure what else to put it in. I'll have to do more research.
You've tried Nepro and said it was good, but pricey. You said the ProT stuff was pretty bad tasting. So what's next on the list to try? Egg whites? I can't find the powdered kind in my store and the ones I see listed on that Davita page aren't available through Amazon. Might look for the liquid kind in the store, but not know which brand is best for us CKD folks.
ProPower bars ($20 for 12 bars look good. I like Healthy Choice Power bowls for a high-protein, well-balanced meal when you just want some quick healthy foods with veggies.
I'm looking at the Healthy Choice Power bowls and I'm seeing like 600mg of sodium, 530mg of potassium along with 26 grams of protein. Do they have any with less sodium and potassium. Doesn't say about phosphorus, so that's an unknown. They look GREAT, just a tad worried about the ingredients, specially the unknown phosphorus, though I don't see any phosphorus additives. mmmm.
My dietician approved the Boost Hi Calorie one. It has 22g protein, 530 calories which I need, 280 mg sodium but the others are hard to read as the label is so small. I got the strawberry as I know the chocolate would be high in phosphorus and I'm kind of not loving vanilla flavored.
Boost, cool. I'll ask about that one. I think it's pretty much available in a lot of places including walmart. One thing that bothers me about my dietician. She really won't comment on specific products like this when I ask. There's probably two reasons. First, I'm sure there's just way to many products out there for her to know the nutritional values of all of em, but second, it's a ton easier to just speak in generalities (as well as reducing her liability for actually suggesting specific products if something negative happens or looking like they're "promoting" certain products). But you would think they would have a "list" of approved renal friendly, high protein products. I've asked, she has no such list, just the "generic" list of food that contains protein, mostly meat of course. So at my clinic, they pretty much leave it up to the patient to figure it all out, other than the generic list and "take this binder". Wish it were not so, but that seems to be the case at our place, which gets a little frustrating, knowing I can't ask specific questions about specific products.
You are at a bigger clinic? I'm at a small independent one and that might be why my dietician works with me one on one if needed. She gave me a list of protein bars, drinks, powders and if I find something I can bring in the information and ask her. Boost is one of the products on the list...not necessarily the high calorie one but I did bring in a bottle and she said it'd be okay.
Hey, THANKS for that list. That's way more than my dietician gave me. To be honest, she just seems a tad on the lazy side. Guess I'll find out more as months roll by, but she never gave me info like that up to now.
So far I like the Boost Strawberry, the Nepro mixed berries, but will drink the vanilla, I eat the NuGo vanilla bars, the Zone Perfect cinnamon rolls. Of course I've had chicken, pork chops, and even some steak but I'm finding it hard to eat them.
I had NuGo bars on my list but have not tried them yet. Have to pick up some once I'm out of Zone cinnamon roll bars. We're actually getting quite a variety of protein sources to choose from. My pantry is going to look like a weight lifter's.
I'm seeing most of these high protein products are marketed to people who are trying to add muscle who don't seem to care about potassium, phosphorus and sodium like we do. Even a google search for high protein for dialysis doesn't really help address the three "bad" guys.
You are exactly right about the high protein industry. And look at that, on the Fresenius page you referenced. Peanut Butter? I would give half my kingdom for a Peanut Butter sammich I may celebrate and have one for lunch (well after tuesday once I know what my potassium level is from my last labs).
I'm kind of tired of the don't eat that but get more protein...more potassium...less phosphorus and yet it seems as if EVERYTHING has phosphorus and god forbid they put the amount on the labels. Of course with two different types of phosphorus-the kind naturally occurring and the added kind. I keep reading that with the natural kind you don't absorb as much. It seems though if it's high protein the phosphorus will be higher.
When they list phosphorus as a % it the RDA for normal people, which I think is 1000 mg. Thus the binders for us on dialysis and the reduced mgs. I really want that transplant so I'm trying to be 100% compliant and I really don't want more exchanges. I do my kt/v again on 4/5 and I hope I pass this time.
Yeah, good luck with that kt/v though I wonder why they do it with for manuals since you're only on it for a short time, rather than waiting till you're on the cycler, then do the kt/v stuff. Did you find out how often they do the kt/v test at your clinic?
The first set of exchanges was somewhat arbitrary so I think they wanted to see how it was working. I would have thought waiting until I'd been on the cycler for at least a month would have been better. It's almost like an experiment...do this and see if that happens. Supposedly it's every quarter but who knows it could be monthly for awhile.
I'm doing a PET on 3/27 the same day I start cycler training. Maybe these are to compare the effect of doing just manual to what the cycler provides. My neph is Indian and does things a little different.
Protein 20g, Sodium 220mg, Potassium 470mg, Phosphorus 25% (25% of what???)
They're all high to me, but again, I guess it depends on your numbers.
According to what I'm seeing on line, a 3 oz skinless, boneless chicken breast has about 190mg phosphorus, a 3 oz thigh contains 135mg phosphorus.
I'm reading that: "For those with CKD and elevated serum phosphorus, usual intakes of phosphorus may be too high and dietary restriction may be needed. A common restriction is 800 mg/day."
So 25% of 800 would be 200mg in a bottle of high protein boost (if that number is correct), which is about the same as that chicken breast, so I guess that's not too bad as long as the binders work. But that's still a lot of potassium for folks who aren't like you and have to restrict potassium. My team hasn't actually commented on my potassium yet. Guess I'll find out more on tuesday when I meet with them. And I mentioned that they don't even test for sodium for some reason.
That's odd that sodium isn't tested for as it's an electrolyte like potassium and you need both. I do track my intake with MyFitnessPal. I'm getting tired of not having my test results given to me....all they do is read them off and say x is good, y is bad, take this binder. I see my doctor on the 15th and there's several things I plan on bringing up.
If it’s not one thing it’s another … potassium…phosphorus…calcium…oh my! I have to take meds for cholesterol, BP, the binder, appetite and one every Sunday for my calcium.
Are we officially "druggies" now. I always wanted to be one in the 70's and just didn't have the nerve Never even tried pot. Might put that on my list for the end of the summer if I can get my dietician to approve it
Woah, looking at the chocolate since it's available currently, (but not vanilla), just saw the back label: Potassium 470mg per scoop. But Davita has this on their recommendation list?? Seems pretty darned high to me. No word on phosphorus though. Sure wish they would list that.
Seems lower in potassium (75), but that's per serving which is only three tablespoons for 5 grams of protein, so if using two servings for 10 grams or three servings for 15 grams of protein, that would give 150 or 225mg potassium. Again NO listing for phosphorus, dang it. How hard could it be for them to include that on the label?
Putting potassium on the label is something new, effective in 2020 I think, maybe 2021, Generally speaking, in the US, FDA makes it a requirement to add something to the label. Apparently it is a big deal, at least to the manufacturer.
look up Paleo Protein…they have 26 G protein and I don’t see any potassium or added phosphorus. Sodium is reasonable. This is th unflavored powder so good for smoothies.
Are you talking about Ancient Cacao, Aztec Vanilla, Mocha Mint or Plain Naked version?? Sweetened with Monk Fruit. What's a monk fruit? Sodium 230, Potassium 165, Probably similar potassium as regular egg whites, but who knows for sure??? If we just knew the potassium level and whether it takes like crap or not, this is definitely an option. Oh, but it's a little pricey at $2.31 a serving from Amazon with Mayan Mocha being a tad more. But still reasonable, but not as cheap per serving as Boost. So who's gonna bit the bullet and try this. I tried Liquacel and wasted $40
So protein intake after several months post-transplant needs to return to a moderate amount according to this trusted site in the US. If in the UK let me know I’ll find a similar link. As always, my best to you post-transplant!
My pleasure and I hope it helped somewhat. If you’d like additional links to post-transplant nutrition let me know. No worries if you don’t want the information as I am known for “information vommit” most of the time. Thus, I try to ask first, that way I don’t dump unneeded information on folks. So completely up to you, I don’t mind doing the research but I don’t mind if you are not interested in further research. Again, my very best to you and your continued healthy recovery.
As always my pleasure. If anything I can provide offers just a little bit of help to someone like you it makes my day. Spent nearly 30 years as a small business owner in the service industry helping people everyday. I am completely disabled and unable to work now so I seek the same fulfillment I had a when working by offering help to CKD patients both face to face and here in this forum. So an extremely LONG-WINDED thank you! Take care and stay on your path to a successful recovery!
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I may celebrate and have one for lunch (well after tuesday once I know what my potassium level is from my last labs). 
Frustrated by Kidney Transplant Evaluation
Kidney transplant recipient 
Kidney diet and protein. 
The first transplant of pig's kidney to human recipient!!
