Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial

Williams, Peter S.; Stevens, M. E.; Fass, G; Irons, L.I.; Bone, J. M.

doi:10.1007/bf00874008

Cited by 31 publications

(50 citation statements)

References 7 publications

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“…In these patients, inadequate food consumption is common as a result of uremic nausea and anorexia, restrictive diet lists, and abstinence from volume overload, while energy and protein needs are increased due to chronic inflammation, proteinuria, inter-current infections and nutrient loss by dialysis procedures, inadequate dialysis and membrane bioincompatibility. While there are studies indicating protein restriction without protein malnutrition slows the progression of CKD [11,12], there are also prospective and randomized studies which did not show such benefit [13,14]. It is also reported that benefits of protein restriction may at least partially be the result of phosphorus restriction with these low-protein diets [15][16][17].…”

Section: Discussionmentioning

confidence: 97%

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

et al. 2014

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Section: Discussionmentioning

confidence: 97%

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

et al. 2014

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“…In fact, by using the study transition probabilities, out of the seven being considered, with the lowest mortality and renal mortality values (Mirescu 2007) [38] for both arms of treatment (consequently with a greater probability to remain in a kidney failure condition), ICER reaches a value of about €8,800 for QALY gained (with a 45% increase versus the base case value of -€19,298), significantly below the threshold of €40,000. Conversely, by using the study transition probabilities with the highest mortality and renal mortality values (Jungers 1987) [40] , ICER is clearly dominant with a -€31,800 value (equal to a 65% decrease versus the base case value). A significant ICER variation occurs when the dialysis costs change: with a 20% increase in costs, we see a decrease in ICER and by contrast, with a 20% decrease in costs, ICER is higher and in both cases it can be quantified as a variation of about 41% of the values obtained in the base case (with ICER equal to -€11,270 in the cost reduction scenario and -€27,326 in the cost increase scenario).…”

Section: Cost-effectiveness Resultsmentioning

confidence: 99%

“…In the analysis conducted by Williams et al in 1991 [39] patients were treated with diets with protein intakes of 0.6 g/kg/day and 0.8 g/kg/day. The duration of the follow-up observation also varied from one study to another, from a minimum of 12 months for the study conducted by Junger et al in 1987 [40] to a maximum of 24 months for the study by Di Iorio et al in 2003 [41] . For this reason, the probabilities were standardised according to the duration of the follow-up period in the individual studies (Table II).…”

Section: Model Probability Estimatementioning

confidence: 99%

Cost-effectiveness analysis for the treatment of chronic kidney disease with low-protein diet

Mennini

Russo

Marcellusi

et al. 2013

FFHD

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ABSTRACT:Background: Several clinical studies have shown that a low protein diet in patients with Chronic Kidney Disease (CKD), delays and prevents the natural progression of the end stage renal disease (ESRD) and the necessary treatment of renal dialysis. Studies to investigate the effects of the low protein diets in preventing severe kidney failure are few for Italy. The aim of this study is to estimate the cost-effectiveness of a low protein diet treatment compared with no dietary treatment in patients with CKD 4-5 after 2, 3, 5 and 10 years.Methods: A Markov model simulating was developed to estimate costs and QALYs associated with low protein treatment and no treatment for patients with CKD 4-5. The prevalence of patients with CKD 4-5 refers to a population aged ≥40 years old was 0.3% estimated by a study of Gambaro et al. on the 2010. The transition probability was estimated on data from seven studies identified by a Cochrane review to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. The Quality Adjusted Life Years (QALYs) scores used were estimated with the Time Trade Off by a study of Gorodetskaya et al. in 2005. The costs of dialysis have been estimated by a study of Censis (2009) and amounted to approximately €34,071.7 per patient per year. The costs of a lowprotein diet refer to contributions of €1,440 per patient per year made by Lazio Region for patients that use a low-protein diet.Main Results / Conclusion: The treatment with a low-protein diet is more effective in terms of QALYs: the difference is always in favour of dietary treatment from a 0.09 after the first two years, 0.17 after three years, 0.37 after five years and up to a differential of 1 year after the first 10 years of treatment. In terms of cost-effectiveness, the dietary treatment is always

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“…However, replacing protein with either carbohydrate or fat in isoenergetic studies may not be neutral as to effect. Of the 33 studies, 10 were not isoenergetic [39,41,44,46,64,71,73,75,80,81] and additionally a further three [58,59,77] did not provide sufficient detail to ascertain this. A number of the studies also failed to assess actual intake (as distinct from prescribed intake) [54,56,57,59,61,64,74,78,80].…”

Section: Resultsmentioning

confidence: 99%

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

Ferrie¹,

Rand²,

Palmer³

2013

FNS

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Aim: To review the supporting evidence for protein requirements in hospitalised adults, and compare the findings with commonly-used guidelines and resources. Methods: a systematic review was conducted based on a computerised bibliographic search of MEDLINE, EMBASE and CINAHL from 1950 to October 2011, as well as a citation review of relevant articles and guidelines. Studies were included if they were randomised clinical trials in hospitalised or chronically ill adults, comparing two or more different levels of protein intake. Information about study quality, setting, and findings was extracted using standardised protocols. Due to the heterogeneity of study characteristics, no meta-analysis was undertaken. Results: 116 papers were obtained in the search and 33 of these met all inclusion criteria. Five studies could not be obtained. The remainder reported outcome measures such as nitrogen balance, anthropometric measurements (including body weight, BMI, and mid-arm circumference), blood electrolyte levels and serum urea, which provide support for recommended protein intakes in various clinical conditions. The results were summarized and compared with current recommendations. Conclusion: high-level evidence to support current recommendations is lacking. The studies reviewed generally agreed with current guidelines and resources.

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Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial

Cited by 31 publications

References 7 publications

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Urea to creatinine ratio: a forgotten marker of poor nutritional state in patients undergoing hemodialysis treatment

Cost-effectiveness analysis for the treatment of chronic kidney disease with low-protein diet

Back to Basics: Estimating Protein Requirements for Adult Hospital Patients. A Systematic Review of Randomised Controlled Trials

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