A Randomized Trial of Low-Protein Diet in Type 1 and in Type 2 Diabetes Mellitus Patients With Incipient and Overt Nephropathy

Dussol, B.; Iovanna, Cecilia; Raccah, D.; Darmon, Patrice; Morange, Sophie; Vague, P; Vialettes, B.; Oliver, Charles; Loundoun, Anderson; Berland, Yvon

doi:10.1053/j.jrn.2005.07.003

Cited by 63 publications

(32 citation statements)

References 28 publications

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“…Most evidence supports moderate restriction of protein intake, but follow-up has typically been short (29)(30)(31). The largest trial, the Modification of Diet in Renal Disease trial, demonstrated no effect of protein restriction on renal function (32,33).…”

Section: Discussionmentioning

confidence: 99%

Higher Biomarker-Calibrated Protein Intake Is Not Associated with Impaired Renal Function in Postmenopausal Women,

Beasley

Aragaki

LaCroix

et al. 2011

The Journal of Nutrition

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With aging, renal function tends to decline, as evidenced by reduced glomerular filtration rate. High-protein intake may further stress the kidneys by causing sustained hyperfiltration. To investigate whether dietary protein is associated with impaired renal function, we used data from 2 nested case-control studies within the Women's Health Initiative Observational Study (n = 2419). We estimated protein intake using a FFQ and estimated glomerular filtration rate (eGFR) from cystatin C. To account for the original study designs, inverse probability weights were applied. Self-reported energy and protein were calibrated using biomarkers of energy and protein intake. Associations between protein intake and renal function were estimated by weighted linear and logistic regression models. Average calibrated protein intake (mean ± SD) was 1.1 ± 0.2 g/(kg body weight·d).Twelve percent (n = 292) of women had impaired renal function. The odds of impaired renal function, defined as eGFR <60 mL/(min·1.73m(2)), was not associated with calibrated protein intake. When eGFR was modeled continuously, there was no association with calibrated protein when protein was expressed in absolute (g/d) or relative to energy (protein % energy/d), but protein relative to body weight [g/(kg body weight·d)] was associated with higher eGFR. There was no evidence for effect modification by age, BMI, or general health status. These data suggest higher protein intake is not associated with impaired renal function among postmenopausal women without a diagnosis of chronic kidney disease.

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Section: Discussionmentioning

confidence: 99%

Higher Biomarker-Calibrated Protein Intake Is Not Associated with Impaired Renal Function in Postmenopausal Women,

Beasley

Aragaki

LaCroix

et al. 2011

The Journal of Nutrition

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“…To the contrary, similar benefits of a low-protein diet were not observed in 69 patients with either type 1 (n 5 32) or type 2 (n 5 37) diabetes and moderately to severely increased albuminuria on a lowprotein (0.6 g/kg/day) diet or a "free" (nonstandardized) protein diet for 12 months (116). Other studies and metaanalyses have also reported negative results (127,135). However, there are many limitations of the previous studies, including combining type 1 and type 2 diabetic patients with varying stages of CKD, inconsistent concurrent management strategies (e.g., RAAS blockers), small sample sizes resulting in lack of statistical power, varying durations of intervention, lack of identification and uniformity of protein sources (e.g., plant versus animal) and other dietary components (fats, carbohydrates, phosphorus, and sodium), and incomplete assessment of dietary adherence.…”

Section: Sodium-glucose Cotransporter 2 Inhibitorsmentioning

confidence: 93%

“…An increasing body of evidence suggests that dietary pattern intake rather than a sole focus on individual nutrients may offer a more practical approach to dietary management of chronic diseases (122-124). (126)(127)(128)(129)(130)(131)(132)(133).Theeffectsofalow-protein (daily intake of 0.6 g protein/kg ideal body weight), low-phosphorus (500-1,000 mg/day) diet were compared with those of a control diet containing $1.0 g protein/kg ideal body weight per day and $1,000 mg phosphorus per day in 35 patients with type 1 diabetes and DKD. Study participants on the lowprotein, low-phosphorus diet had a slower rate of decline in iothalamate GFR over the course of the study.…”

Section: Sodium-glucose Cotransporter 2 Inhibitorsmentioning

confidence: 99%

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

Tuttle

Bakris

Bilous

et al. 2014

American Journal of Kidney Diseases

648

604

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The incidence and prevalence of diabetes mellitus have grown significantly throughout the world, due primarily to the increase in type 2 diabetes. This overall increase in the number of people with diabetes has had a major impact on development of diabetic kidney disease (DKD), one of the most frequent complications of both types of diabetes. DKD is the leading cause of end-stage renal disease (ESRD), accounting for approximately 50% of cases in the developed world. Although incidence rates for ESRD attributable to DKD have recently stabilized, these rates continue to rise in high-risk groups such as middle-aged African Americans, Native Americans, and Hispanics. The costs of care for people with DKD are extraordinarily high. In the Medicare population alone, DKD-related expenditures among this mostly older group were nearly $25 billion in 2011. Due to the high human and societal costs, the Consensus Conference on Chronic Kidney Disease and Diabetes was convened by the American Diabetes Association in collaboration with the American Society of Nephrology and the National Kidney Foundation to appraise issues regarding patient management, highlighting current practices and new directions. Major topic areas in DKD included 1) identification and monitoring, 2) cardiovascular disease and management of dyslipidemia, 3) hypertension and use of renin-angiotensin-aldosterone system blockade and mineralocorticoid receptor blockade, 4) glycemia measurement, hypoglycemia, and drug therapies, 5) nutrition and general care in advanced-stage chronic kidney disease, 6) children and adolescents, and 7) multidisciplinary approaches and medical home models for health care delivery. This current state summary and research recommendations are designed to guide advances in care and the generation of new knowledge that will meaningfully improve life for people with DKD.

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“…[31][32][33][34] A low-protein diet has not reduced the risk of mortality or ESRD compared with a usual protein diet, at least in the course of CKD stages 1-3. [35][36][37][38][39] Screening for patients with chronic kidney disease stage 1-3: facts and fallacies…”

Section: Methods Of Researchmentioning

confidence: 99%

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

Meschi

Esposti

et al. 2013

Ital J Med

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A Randomized Trial of Low-Protein Diet in Type 1 and in Type 2 Diabetes Mellitus Patients With Incipient and Overt Nephropathy

Cited by 63 publications

References 28 publications

Higher Biomarker-Calibrated Protein Intake Is Not Associated with Impaired Renal Function in Postmenopausal Women,

Higher Biomarker-Calibrated Protein Intake Is Not Associated with Impaired Renal Function in Postmenopausal Women,

Diabetic Kidney Disease: A Report From an ADA Consensus Conference

Referral to sub-specialists: who have the most to gain from early specialist intervention among patients with markers of renal disease?

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