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Protein restriction for diabetic renal disease
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Robertson, Lynn M., Waugh, Norman and Robertson, Aileen (2007) Protein restriction for diabetic renal disease. Cochrane Database of Systematic Reviews, 2009 (1). CD002181. doi:10.1002/14651858.CD002181.pub2 ISSN 1469-493X.
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Official URL: http://dx.doi.org/10.1002/14651858.CD002181.pub2
Abstract
Background
Diabetic renal disease (diabetic nephropathy) is a leading cause of end‐stage renal failure. Once the process has started, it cannot be reversed by glycaemic control, but progression might be slowed by control of blood pressure and protein restriction.
Objectives
To assess the effects of dietary protein restriction on the progression of diabetic nephropathy in patients with diabetes.
Search methods
We searched The Cochrane Library, MEDLINE, EMBASE, ISI Proceedings, Science Citation Index Expanded and bibliographies of included studies.
Selection criteria
Randomised controlled trials (RCTs) and before and after studies of the effects of a modified or restricted protein diet on diabetic renal function in people with type 1 or type 2 diabetes following diet for at least four months were considered.
Data collection and analysis
Two reviewers performed data extraction and evaluation of quality independently. Pooling of results was done by means of random‐effects model.
Main results
Twelve studies were included, nine RCTs and three before and after studies. Only one study explored all‐cause mortality and end‐stage renal disease (ESRD) as endpoints. The relative risk (RR) of ESRD or death was 0.23 (95% confidence interval (CI) 0.07 to 0.72) for patients assigned to a low protein diet (LPD). Pooling of the seven RCTs in patients with type 1 diabetes resulted in a non‐significant reduction in the decline of glomerular filtration rate (GFR) of 0.1 ml/min/month (95% CI ‐0.1 to 0.3) in the LPD group. For type 2 diabetes, one trial showed a small insignificant improvement in the rate of decline of GFR in the protein‐restricted group and a second found a similar decline in both the intervention and control groups. Actual protein intake in the intervention groups ranged from 0.7 to 1.1 g/kg/day. One study noted malnutrition in the LPD group. We found no data on the effects of LPDs on health‐related quality of life and costs.
Authors' conclusions
The results show that reducing protein intake appears to slightly slow progression to renal failure but not statistically significantly so. However, questions concerning the level of protein intake and compliance remain. Further longer‐term research on large representative groups of patients with both type 1 and type 2 diabetes mellitus is necessary. Because of the variability amongst patients, there might perhaps be a six month therapeutic trial of protein restriction in all individuals, with continuation only in those who responded best. Trials are required of different types of protein.
| Item Type: | Journal Article | ||||
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| Subjects: | R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Diabetic nephropathies, Diabetic nephropathies -- Diet therapy, Low-protein diet , Diabetes -- Diseases -- Nutritional aspects, Chronic renal failure , Chronic renal failure -- Diet therapy | ||||
| Journal or Publication Title: | Cochrane Database of Systematic Reviews | ||||
| Publisher: | John Wiley & Sons Ltd. | ||||
| ISSN: | 1469-493X | ||||
| Official Date: | 17 October 2007 | ||||
| Dates: |
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| Volume: | 2009 | ||||
| Number: | 1 | ||||
| Number of Pages: | 25 | ||||
| Article Number: | CD002181 | ||||
| DOI: | 10.1002/14651858.CD002181.pub2 | ||||
| Status: | Peer Reviewed | ||||
| Publication Status: | Published | ||||
| Access rights to Published version: | Restricted or Subscription Access | ||||
| Copyright Holders: | The Cochrane Collaboration | ||||
| Date of first compliant deposit: | 15 November 2022 | ||||
| Date of first compliant Open Access: | 16 November 2022 |
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