In the last 5 to 6 decades there has been a marked variation in use of dietary protein restriction (DPR) in treatment of patients with chronic kidney disease (CKD). Before availability of renal replacement therapy (RRT), DPR restriction was widely practised in uraemic patients to reduce generation of nitrogenous waste products and ameliorate uraemic symptoms. With availability of RRT, the interest in DPR was lost. There was a resurgence of interest in DPR when animal experimental studies suggested that DPR can retard the progression of CKD. Then there was concern about worsening nutritional status with DPR. This article reviews how the role of DPR in treatment of CKD as perceived by physicians has varied over the years and suggests a strategy that should be followed in India considering that RRT is available to a very small percentage of cases developing end stage kidney disease (ESKD).
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