American Journal of Kidney Diseases
Volume 54, Issue 6 , Pages 1052-1061 , December 2009

Effect of a Low- Versus Moderate-Protein Diet on Progression of CKD: Follow-up of a Randomized Controlled Trial

  • Bruno Cianciaruso, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
    • Corresponding Author InformationAddress correspondence to Bruno Cianciaruso, MD, Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Andrea Pota, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Vincenzo Bellizzi, MD

      Affiliations

    • Nephrology and Dialysis Unit, A. Landolfi Hospital, Solofra (AV), Italy
  • ,
  • Daniela Di Giuseppe, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Lucia Di Micco, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Roberto Minutolo, MD

      Affiliations

    • Department of Nephrology, Second University of Naples, Italy
  • ,
  • Antonio Pisani, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Massimo Sabbatini, MD

      Affiliations

    • Department of Nephrology, University Federico II of Naples, Italy
  • ,
  • Pietro Ravani, MD

      Affiliations

    • Department of Medicine, University of Calgary, Alberta, Canada
    • Department of Community Health Sciences, University of Calgary, Alberta, Canada

Received 21 January 2009 ,Accepted 13 July 2009.

References 

  1. Kopple JD, Coburn JW. Metabolic studies of low protein diets in uremia (I. Nitrogen and potassium). Medicine. 1973;52:593–595
  2. Mitch WE, Remuzzi G. Diets for patients with chronic kidney disease, still worth prescribing. J Am Soc Nephrol. 2004;15:234–237
  3. Mitch WE. Beneficial responses to modified diets in treating patients with chronic kidney disease. Kidney Int Suppl. 2005;94:S133–S135
  4. Cianciaruso B, Pota A, Pisani A, et al. Metabolic effects of two low protein diets in chronic kidney disease stage 4-5—a randomized controlled trial. Nephrol Dial Transplant. 2008;23(2):636–644
  5. Aparicio M, Lafage MH, Combe C, et al. Low-protein diet and renal osteodystrophy. Nephron. 1991;58:250–252
  6. Barsotti G, Cupisti A. The role of dietary phosphorus restriction in the conservative management of chronic renal disease. J Ren Nutr. 2005;15(1):189–192
  7. Cianciaruso B, Bellizzi V, Minutolo R, et al. Renal adaptation to dietary sodium restriction in moderate renal failure resulting from chronic glomerular disease. J Am Soc Nephrol. 1996;7:306–313
  8. Bellizzi V, Di Iorio BR, De Nicola L, et al. ERIKA Study Group Very low protein diet supplemented with ketoanalogs improves blood pressure control in chronic kidney disease. Kidney Int. 2007;71(3):245–251
  9. Percheron C, Colette C, Astre C, Monnier L. Effects of moderate changes in protein intake on urinary albumin excretion in type I diabetic patients. Nutrition. 1995;11:345–349
  10. Gansevoort RT, de Zeeuw D, de Jong PE. Additive antiproteinuric effect of ACE inhibition and a low-protein diet in human renal disease. Nephrol Dial Transplant. 1995;10:497–504
  11. Di Iorio BR, Minutolo R, De Nicola L, et al. Supplemented very low protein diet ameliorates responsiveness to erythropoietin in chronic renal failure. Kidney Int. 2003;64(5):1822–1828
  12. Go A, Chertow G, Donjiel Fan MPH, et al. Chronic kidney disease and risk of death, cardiovascular events and hospitalization. N Engl J Med. 2004;23:1296–1305
  13. Levey AS, Greene T, Sarnak MJ, et al. Effect of dietary protein restriction on the progression of kidney disease: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis. 2006;48:879–888
  14. National Kidney Foundation. Guideline 1: goals of antihypertensive therapy in CKD. In: K/DOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease. Am J Kidney Dis. 2004;43(suppl 1):S65–S230
  15. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease. Am J Kidney Dis. 2003;42(suppl 3):S1–S201
  16. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Managing Dyslipidemias in Chronic Kidney Disease. Am J Kidney Dis. 2003;41(suppl 3):
  17. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: Update 2000. Am J Kidney Dis. 2001;37:182–238
  18. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130:461–470
  19. FAO/WHO/UNU. Energy and protein requirements (Report of a joint expert consultation). World Health Organ Tech Rep Ser. 1985;724:1–206
  20. Food and Nutrition Board. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids (macronutrients). In: Dietary Reference Intakes. Washington DC: National Academy Press; 2002;p. 1–8
  21. Charlson ME, Pompei P, Ales KL. A new method of classifyng prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383
  22. Maroni BJ, Steinman TI, Mitch WE. A method for estimating nitrogen intake of patients with chronic renal failure. Kidney Int. 1985;27:58–65
  23. Heymsfield SB, Arteaga C, McManus C, et al. Measurement of muscle mass in humans: validity of the 24-hour urinary creatinine method. Am J Clin Nutr. 1983;37:478–494
  24. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Hemodialysis Adequacy, 2000. Am J Kidney Dis. 2001;37(suppl 1):S7–S64
  25. Wei L, Lin D, Weissfeld L. Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. J Am Stat Assoc. 1989;84:1065–1073
  26. Kleinbaum DG, Klein M. Modelling strategy guidelines and modelling strategy for assessing interaction and confounding. In: Logistic Regression: A Self-Learning Test. New York, NY: Springer-Verlag; 2002;p. 130–226
  27. National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure. Am J Kidney Dis. 2000;35(6 suppl 2):
  28. Prichard S. Clinical Practice Guidelines of the Canadian Society of Nephrology for the treatment of patients with chronic renal failure: a re-examination. Contrib Nephrol. 2003;140:163–169
  29. Cianciaruso B, Barsotti G, Oldrizzi L, Gentile MG, Del Vecchio L. Italian Society of Nephrology (Conservative therapy guidelines for chronic renal failure). G Ital Nefrol. 2003;20(suppl 24):S48–S60
  30. Menon V, Wang X, Sarnak MJ, et al. Long-term outcomes in nondiabetic chronic kidney disease. Kidney Int. 2008;73(11):1310–1315
  31. Levin A, Djurdjev O, Beaulieu M, Er L. Variability and risk factors for kidney disease progression and death following attainment of stage 4 CKD in a referred cohort. Am J Kidney Dis. 2008;52(4):661–671
  32. Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G. Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Lancet. 1998;352:1252–1256

 Originally published online as doi:10.1053/j.ajkd.2009.07.021 on October 5, 2009.

 Trial registration: www.controlled-trials.com; study number: ISRCTN58881100.

PII: S0272-6386(09)01078-6

doi: 10.1053/j.ajkd.2009.07.021

American Journal of Kidney Diseases
Volume 54, Issue 6 , Pages 1052-1061 , December 2009