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Cited by 234Chronic Kidney Disease and DiabetesDiet and metabolism studiesDialysis and Renal Disease Management

Protein restriction for diabetic renal disease

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Robertson, Lynn M, Waugh, Norman, Robertson, Aileen·2007·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd002181.pub2PMC PMC8984680
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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 STRATEGY: 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.

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  • A review of 4 studies among people with Type 2 diabetes noted small but insignificant reductions in the rate of declining kidney function in 3 of them.

    “A review of 4 studies among people with Type 2 diabetes again noted small but insignificant reductions in the rate of declining kidney function in 3 of them.”

    From Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group (2013) · cites this paper as [103]

    The “Type 2 diabetes mellitus” section (page unavailable) describes four studies that included people with type 2 diabetes, but only one found a small, statistically insignificant improvement in the rate of GFR decline. Two found similar renal-function outcomes, while one found a statistically significant improvement; the latter two studies also included people with type 1 diabetes and did not report separate results. (LLM, conf=0.90)

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  • In individuals with diabetes and non-dialysis-dependent DKD, reducing dietary protein below 0.8 g/kg body weight/day does not meaningfully alter glycemic measures, cardiovascular risk measures, or the course of glomerular filtration rate decline and may increase risk for malnutrition.

    “In individuals with diabetes and non -dialysis-dependent diabetic kidney disease (DKD), reducing the amount of dietary protein below the recommended daily allowance (0.8 g/kg body weight/day) does not meaningfully alter glycemic measures, cardiovascular risk measures, or the course of glomerular fi ltration rate decline and may increase risk for malnutrition.”

    From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [320]

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  • Historically, low-protein eating plans in DKD typically improved albuminuria but had no clear effect on estimated glomerular filtration rate.

    “Historically, low-protein eating plans were advised to reduce albuminuria and progression of chronic kidney disease in people with DKD, typically with improvements in albuminuria but no clear effect on estimated glomerular fi ltration rate.”

    From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [320]

    The Main results (page not provided) report no statistically significant effect on the decline in GFR, supporting the 'no clear effect' portion, although the review reports GFR rather than explicitly estimated GFR. The Discussion (page not provided) mentions reduced albumin excretion in one predominantly vegetarian-diet study, but says the result was confounded by a drop in total protein intake; it does not establish that low-protein diets typically improved albuminuria. The review also says protein restriction appeared to be little used in routine diabetes care, so it does not substantiate how commonly it was advised. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Historically, low-protein eating plans in DKD typically improved albuminuria but had no clear effect on estimated glomerular filtration rate.

    “Historically, low-protein eating plans were advised to reduce albuminuria and progression of chronic kidney disease in people with DKD, typically with improvements in albuminuria but no clear effect on estimated glomerular fi ltration rate.”

    From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [319]

    The Main results report no statistically significant improvement in the rate of GFR decline with protein restriction, supporting the claim of no clear GFR effect, though the review reports GFR rather than specifically estimated GFR. The Discussion mentions reduced albumin excretion in one study of a predominantly vegetarian diet, confounded by lower total protein intake; it does not establish that low-protein diets typically improved albuminuria. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In individuals with diabetes and non-dialysis-dependent DKD, reducing dietary protein below 0.8 g/kg body weight/day does not meaningfully alter glycemic measures, cardiovascular risk measures, or the course of glomerular filtration rate decline and may increase risk for malnutrition.

    “In individuals with diabetes and non -dialysis-dependent diabetic kidney disease (DKD), reducing the amount of dietary protein below the recommended daily allowance (0.8 g/kg body weight/day) does not meaningfully alter glycemic measures, cardiovascular risk measures, or the course of glomerular fi ltration rate decline and may increase risk for malnutrition.”

    From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [319]

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Cites

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Research works printed but not linked: 35

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  10. Hansen 1999 {published data only} Hansen HP, Christensen PK, Tauber-Lassen E, Klausen A, Jensen BR, Parving H-H. Low-protein diet and kidney function in insulin-dependent diabetic patients with diabetic nephropathy. Kidney International 1999;55:621-628.
  11. Jibani 1991 {published data only} Jibani MM, Bloodworth LL, Foden E, Griffiths KD, Galpin OP. Predominantly vegetarian diet in patinets with incipient and early clinical diabetic nephropathy: effects on albumin excretion rate and nutritional status. Diabetic Medicine 1991;8:949-53.
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Authors
Robertson, L. M., Waugh, N., & Robertson, A.
Affiliations
  • University of Aberdeen (GB)
  • Aberdeen Royal Infirmary (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2007-10-17
Volume
2009
Issue
1
Pages
CD002181-CD002181
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd002181.pub2
PMC
PMC8984680
OpenAlex
W1775321216
Cited by
234
References
3
Citations by year
2026: 1 · 2025: 2 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 11 · 2020: 13 · 2019: 15 · 2018: 8 · 2017: 21 · 2016: 18 · 2015: 16 · 2014: 24 · 2013: 18 · 2012: 13
FWCI
1.80
Type
journal article
Language
en
Open access
Licence
other-oa
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion, other-oa)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
Keywords
diabetic nephropathy, protein restriction, low-protein diet, type 1 diabetes, type 2 diabetes, end-stage renal disease, glomerular filtration rate decline, malnutrition
MeSH terms
Diabetic Nephropathies, Dietary Proteins, Humans, Randomized Controlled Trials as Topic, Diet, Protein-Restricted, Renal Insufficiency

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