• Assessment
    What is the evidence for the effectiveness of restricted protein intake and nephrotic syndrome? (2001 CD)
    • Conclusion

      Patients with nephrotic syndrome participating in randomized control trials were in positive nitrogen balance on 0.7 to 0.8 g protein/kg IBW + 1 g dietary protein for every 1 g of urinary protein and 35 kcal/kg. GFR ranges were ~50 to 92 ml/min. This level of protein restriction also decreased proteinuria and increased serum albumin concentrations. Long-term studies evaluating the progression of kidney disease are lacking in this population.

       

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the relationship between protein restriction and diabetic nephropathy? (2001 CD)
    • Conclusion

      Patients with both type 1 and 2 diabetes showed significant reductions in urinary albumin excretion with protein restrictions of 0.8 to 1.1 g/kg/IBW and GFR ranging between 50 and 94 ml/min in randomized controlled trials 6 to 12 months in duration.

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What is the evidence for the effectiveness of restricted protein intake and chronic kidney disease? (2001 CD)
    • Conclusion

      Randomized controlled trials in subjects with GFR ~15 ml/min and dietary protein intakes of 0.3 to 0.6 g/kg/ IBW supplemented with ketoacids demonstrated a decrease in the decline of GFR and delayed renal replacement therapy. Ketoacid supplements were more effective than amino acid supplements in most studies in delaying the progression of kidney disease. The Modification of Diet in Renal Disease (MDRD) study reported a 35% to 46% compliance rate in subjects consuming ~0.6 g protein/kg/IBW and a 25% compliance rate to 0.3 g protein/kg/IBW. Subjects received monthly nutrition counseling with a dietitian in all studies. Therefore, clinical judgment should be used in selecting patients for protein intakes <0.8 g/kg/IBW (The Recommended Dietary Allowance for protein) considering the level of motivation, willingness to participate in frequent follow-up, and risk for protein/calorie malnutrition.

       

    • Grade: I
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.