Stage 4 Kidney Disease and Protein

[magadorm]

Hello,

My mother was recently upgraded to CKD Stage 4 Kidney Disease. She is 69 years old and the kidney disease is due to liver damage from chronic alcoholism, she is now sober for 4 years.
She is not wanting to do the program and I have respected her wishes there. But, she has been asking for advice for diet.

Her are her latest lab results:
Creatinine ratio: 36
Albumin, Urine: 11.6
Creatinine, Urine: 31.9
Cholesterol total: 217
HDL: 77
LDL: 124
Triglycerides: 93 vdl
Metabolic panel creatinine 1.48
eGFR: 38
A1C: 5.1
B/P: 120/80

Due to her kidney disease what kind of protein intake should she be trying to get?
I know there are concerns about malnourishment in these situations, but what would be the best course of action?
She is currently seeing a PT for physical therapy as she is recovering from some surgeries and mobility issues.
She is actually seeing some results and I have been trying to guide her as much as she will allow.
She is a little overweight, but has lost about 100 pounds since she stopped drinking 4 years ago.
Thank you in advance for any guidance.

[Robert Santana]

As a renal dietitian in my past life I'm going to say that your mother needs to train. Dialysis is inevitable, it's just a matter of when at this point. All the protein in the world will not stop the wasting that will follow. I've seen too many people come in completely ambulatory and then end up in a gurney within a few years. That said, to answer your question it depends on who you ask. Some nephrologists prioritize preventing malnutrition and keeping protein intake normal and others prioritize delaying dialysis and going with a low protein intake. She isn't training and she isn't on dialysis right now so she doesn't need a very high amount but she also has failing kidneys so too much can accelerate the progression of the disease. The answer, in this case, is somewhere in the middle especially because she refuses to train. Probably want to delay dialysis as long as possible while preventing malnutrition.

[magadorm]

Thank you for the reply coach. I will keep trying to get her to train.

[Robert Santana]

You are welcome. All the protein in the world will not offset the lack of stimulus.