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Cited by 334Chronic Kidney Disease and DiabetesDialysis and Renal Disease ManagementDiet and metabolism studies

Effects of dietary protein restriction on the progression of advanced renal disease in the Modification of Diet in Renal Disease study

Levey, Andrew S., Adler, Sharon, Caggiula, Arlene W., England, Brian K., Greene, Tom, Hunsicker, Lawrence G., Kusek, John W., Rogers, Nancy L. +1 more·1996·American Journal of Kidney Diseases
DOI 10.1016/s0272-6386(96)90099-2
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Abstract

Patients with advanced renal disease randomized to the very low-protein diet group in the Modification of Diet in Renal Disease (MDRD) Study had a marginally (P = 0.066) slower mean glomerular filtration rate (GFR) decline compared with patients randomized to the low-protein diet group. The objective of these secondary analyses was to determine the relationship between achieved, in addition to prescribed, dietary protein intake and the progression of advanced renal disease. A randomized controlled trial was conducted in patients with chronic renal diseases of diverse etiology. The average follow-up was 2.2 years. Fifteen university hospital outpatient nephrology practices participated in the study, which comprised 255 patients aged 18 to 70 years with a baseline GFR 13 to 24 mL/min/1.73 m2 who participated in MDRD Study B. Patients with diabetes requiring insulin were excluded. The patients were given a low-protein (0.58 g/kg/d) or very low-protein (0.28 g/kg/d) diet supplemented with keto acids-amino acids (0.28 g/kg/d). Outcomes were measured by comparisons of protein intake from food or from food and supplement between randomized groups, and correlations of protein intake with rate of decline in GFR and time to renal failure or death. Comparison of the randomized groups showed that total protein intake from food and supplement was lower (P < 0.001) among patients randomized to the very low-protein diet (0.66 g/kg/d) compared with protein intake from food only in patients randomized to the low-protein diet (0.73 g/kg/d). In correlational analyses, we combined patients assigned to both diets and controlled for baseline factors associated with a faster progression of renal disease. A 0.2 g/kg/d lower achieved total protein intake (including food and supplement) was associated with a 1.15 mL/min/yr slower mean decline in GFR (P = 0.011), equivalent to 29% of the mean GFR decline. After adjusting for achieved total protein intake, no independent effect of prescription of the keto acid-amino acid supplement to slow the GFR decline could be detected. If the GFR decline is extrapolated until renal failure, a patient with a 29% reduction in the rate of GFR decline would experience a 41% prolongation in the time to renal failure. Additional analyses confirmed a longer time to renal failure in patients with lower total protein intake. In conclusion, these secondary analyses of the MDRD Study suggest that a lower protein intake, but not the keto acid-amino acid supplement, retards the progression of advanced renal disease. In patients with GFR less than 25 mL/min/1.73 m2, we suggest a prescribed dietary protein intake of 0.6 g/kg/d.

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Authors
Levey, A. S., Adler, S., Caggiula, A. W., England, B. K., Greene, T., Hunsicker, L. G., Kusek, J. W., Rogers, N. L., & Teschan, P. E.
Affiliations
National Institutes of Health (US)
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
1996-05
Volume
27
Issue
5
Pages
652-663
ISSN
0272-6386 (ISSN-L)
DOI
10.1016/s0272-6386(96)90099-2
OpenAlex
W1995286167
Cited by
334
References
50
Citations by year
2026: 3 · 2025: 6 · 2024: 7 · 2023: 7 · 2022: 4 · 2021: 13 · 2020: 12 · 2019: 10 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 13 · 2014: 11 · 2013: 18 · 2012: 14
FWCI
16.72
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • University of Pittsburgh
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
Keywords
protein restriction, very low protein diet, chronic kidney disease progression, glomerular filtration rate decline, MDRD Study, protein intake, renal failure, proteinuria, proteinuria reduction
MeSH terms
Adolescent, Adult, Aged, Amino Acids, Chronic Disease, Creatinine, Dietary Proteins, Female, Follow-Up Studies, Food, Fortified, Glomerular Filtration Rate, Humans, Keto Acids, Kidney Diseases, Male, Middle Aged, Proteinuria, Treatment Outcome, Disease Progression, Diet, Protein-Restricted, Renal Insufficiency

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