Low protein diets for non-diabetic adults with chronic kidney disease

Abstract

Background Chronic kidney disease (CKD) is defined as reduced function of the kidneys present for 3 months or longer with adverse implications for health and survival. For several decades low protein diets have been proposed for participants with CKD with the aim of slowing the progression to end-stage kidney disease (ESKD) and delaying the onset of renal replacement therapy. However the relative benefits and harms of dietary protein restriction for preventing progression of CKD have not been resolved. This is an update of a systematic review first published in 2000 and updated in 2006 and 2009. Objectives To determine the e icacy of low protein diets in preventing the natural progression of CKD towards ESKD and in delaying the need for commencing dialysis treatment in non-diabetic adults. Search methods We searched the Cochrane Kidney and Transplant Register of Studies up to 2 March 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. Selection criteria We included randomised controlled trials (RCTs) or quasi RCTs in which adults with non-diabetic chronic kidney disease (stages 3 to 5) not on dialysis were randomised to receive a very low protein intake (0.3 to 0.4 g/kg/d) compared with a low protein intake (0.5 to 0.6 g/kg/d) or a low protein intake compared with a normal protein intake (≥ 0.8 g/kg/d) for 12 months or more. Data collection and analysis Two authors independently selected studies and extracted data. For dichotomous outcomes (death, all causes), requirement for dialysis, adverse e ects) the risk ratios (RR) with 95% confidence intervals (CI) were calculated and summary statistics estimated using the random e ects model. Where continuous scales of measurement were used (glomerular filtration rate (GFR), weight), these data were analysed as the mean di erence (MD) or standardised mean di erence (SMD) if di erent scales had been used. The certainty of the evidence was assessed using GRADE.

Rethinking Onconephrology: A Nephro-Nutritional Integrated Approach in Patients with Chronic Kidney Disease and Urological Malignancies

“…Both measured GFR, assessed by iohexol plasma clearance, and estimated GFR remained stable throughout follow-up. This is in line with previous studies showing that low-protein diets may stabilize renal function in CKD [ 6 , 7 , 8 ]. The absence of decline in GFR, despite protein intake frequently below 0.8 g/kg/day, supports the safety of this approach when nutritional status is maintained.…”

Rethinking Onconephrology: A Nephro-Nutritional Integrated Approach in Patients with Chronic Kidney Disease and Urological Malignancies

“…Both measured GFR, assessed by iohexol plasma clearance, and estimated GFR remained stable throughout follow-up. This is in line with previous studies showing that low-protein diets may stabilize renal function in CKD [ 6 , 7 , 8 ]. The absence of decline in GFR, despite protein intake frequently below 0.8 g/kg/day, supports the safety of this approach when nutritional status is maintained.…”

Low-Protein Diets and Plant-Based Diets in Chronic Kidney Disease: Understanding Dietitians’ Perspectives and Practice Trends

“…These findings are consistent with previously reported barriers [33]. Nevertheless, KAsupplemented LPDs/VLPDs have been shown to improve kidney function, delay CKD progression, and preserve skeletal muscle mass [13,14,16,[33][34][35][36][37][38]. To mitigate the risk of malnutrition, KA-supplemented LPDs/VLPDs should be administered under the close supervision of a clinician familiar with KA use [8].…”

Association between Low Protein Intake and Mortality in Patients with Type 2 Diabetes

“…In the present study, the changes in eGFR were not significantly different among the quartile groups of protein intake. The evidence regarding the effects of protein intake on renal function has been inconsistent [35][36][37]. In our study, patients' renal function was maintained, and the mean protein intake in the highest group was 1.7 ± 0.3 g/day/kg BW.…”

Rethinking Onconephrology: A Nephro-Nutritional Integrated Approach in Patients with Chronic Kidney Disease and Urological Malignancies

“…Both measured GFR, assessed by iohexol plasma clearance, and estimated GFR remained stable throughout follow-up. This is in line with previous studies showing that low-protein diets may stabilize renal function in CKD [ 6 , 7 , 8 ]. The absence of decline in GFR, despite protein intake frequently below 0.8 g/kg/day, supports the safety of this approach when nutritional status is maintained.…”

Low-Protein Diets and Plant-Based Diets in Chronic Kidney Disease: Understanding Dietitians’ Perspectives and Practice Trends

“…These findings are consistent with previously reported barriers [33]. Nevertheless, KAsupplemented LPDs/VLPDs have been shown to improve kidney function, delay CKD progression, and preserve skeletal muscle mass [13,14,16,[33][34][35][36][37][38]. To mitigate the risk of malnutrition, KA-supplemented LPDs/VLPDs should be administered under the close supervision of a clinician familiar with KA use [8].…”

Association between Low Protein Intake and Mortality in Patients with Type 2 Diabetes

“…In the present study, the changes in eGFR were not significantly different among the quartile groups of protein intake. The evidence regarding the effects of protein intake on renal function has been inconsistent [35][36][37]. In our study, patients' renal function was maintained, and the mean protein intake in the highest group was 1.7 ± 0.3 g/day/kg BW.…”

Rethinking Onconephrology: A Nephro-Nutritional Integrated Approach in Patients with Chronic Kidney Disease and Urological Malignancies

“…Both measured GFR, assessed by iohexol plasma clearance, and estimated GFR remained stable throughout follow-up. This is in line with previous studies showing that low-protein diets may stabilize renal function in CKD [ 6 , 7 , 8 ]. The absence of decline in GFR, despite protein intake frequently below 0.8 g/kg/day, supports the safety of this approach when nutritional status is maintained.…”

Low-Protein Diets and Plant-Based Diets in Chronic Kidney Disease: Understanding Dietitians’ Perspectives and Practice Trends

“…These findings are consistent with previously reported barriers [33]. Nevertheless, KAsupplemented LPDs/VLPDs have been shown to improve kidney function, delay CKD progression, and preserve skeletal muscle mass [13,14,16,[33][34][35][36][37][38]. To mitigate the risk of malnutrition, KA-supplemented LPDs/VLPDs should be administered under the close supervision of a clinician familiar with KA use [8].…”

Association between Low Protein Intake and Mortality in Patients with Type 2 Diabetes

“…In the present study, the changes in eGFR were not significantly different among the quartile groups of protein intake. The evidence regarding the effects of protein intake on renal function has been inconsistent [35][36][37]. In our study, patients' renal function was maintained, and the mean protein intake in the highest group was 1.7 ± 0.3 g/day/kg BW.…”