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The Effects of Dietary Protein Restriction and Blood-Pressure Control on the Progression of Chronic Renal Disease
Open accessAbstract
BACKGROUND: Restricting protein intake and controlling hypertension delay the progression of renal disease in animals. We tested these interventions in 840 patients with various chronic renal diseases. METHODS: In study 1, 585 patients with glomerular filtration rates of 25 to 55 ml per minute per 1.73 m2 of body-surface area were randomly assigned to a usual-protein diet or a low-protein diet (1.3 or 0.58 g of protein per kilogram of body weight per day) and to a usual- or a low-blood-pressure group (mean arterial pressure, 107 or 92 mm Hg). In study 2, 255 patients with glomerular filtration rates of 13 to 24 ml per minute per 1.73 m2 were randomly assigned to the low-protein diet (0.58 g per kilogram per day) or a very-low-protein diet (0.28 g per kilogram per day) with a keto acid-amino acid supplement, and a usual- or a low-blood-pressure group (same values as those in study 1). An 18-to-45-month follow-up was planned, with monthly evaluations of the patients. RESULTS: The mean follow-up was 2.2 years. In study 1, the projected mean decline in the glomerular filtration rate at three years did not differ significantly between the diet groups or between the blood-pressure groups. As compared with the usual-protein group and the usual-blood-pressure group, the low-protein group and the low-blood-pressure group had a more rapid decline in the glomerular filtration rate during the first four months after randomization and a slower decline thereafter. In study 2, the very-low-protein group had a marginally slower decline in the glomerular filtration rate than did the low-protein group (P = 0.07). There was no delay in the time to the occurrence of end-stage renal disease or death. In both studies, patients in the low-blood-pressure group who had more pronounced proteinuria at base line had a significantly slower rate of decline in the glomerular filtration rate. CONCLUSIONS: Among patients with moderate renal insufficiency, the slower decline in renal function that started four months after the introduction of a low-protein diet suggests a small benefit of this dietary intervention. Among patients with more severe renal insufficiency, a very-low-protein diet, as compared with a low-protein diet, did not significantly slow the progression of renal disease.
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“Compared with a noneproteinlimited diet, a low-protein diet of 0.6 g/kg BW/d can prevent a decline in GFR of approximately 1 mL/min per year per 1.73 m 2 and is associated with a 30% decrease in reaching a dialysisdependent stage.114,115”
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 [115]
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“Reducing the amount of dietary protein below the recommended daily allowance of 0.8 g/kg/day is not recommended because it does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline (46).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [46]
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“In people with CKD and diabetes, consuming protein below the recommended daily allowance of 0.8 g/kg/day is not recommended, because it does not alter blood glucose levels, cardiovascular risk measures, or the course of GFR decline (48).”
From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [48]
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“Under those conditions, the development of malnutrition during a low-protein diet is an extremely rare event.115”
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 [115]
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Metadata
- Authors
- Klahr, S., Levey, A. S., Beck, G. J., Caggiula, A. W., Hunsicker, L., Kusek, J. W., & Striker, G.
- Affiliations
- National Institutes of Health (US)
- Tufts Medical Center (US)
- Cleveland Clinic (US)
- University of Pittsburgh (US)
- University of Iowa Hospitals and Clinics (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1994-03-31
- Volume
- 330
- Issue
- 13
- Pages
- 877-884
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2321986725
- Semantic Scholar
- 01e2c22d0073b85c7e2ba3a9327f2c898329d6af
- Cited by
- 2,328
- References
- 30
- Citations by year
- 2026: 25 · 2025: 53 · 2024: 56 · 2023: 66 · 2022: 64 · 2021: 74 · 2020: 73 · 2019: 82 · 2018: 81 · 2017: 98 · 2016: 82 · 2015: 84 · 2014: 100 · 2013: 92 · 2012: 92
- FWCI
- 51.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- chronic kidney disease, protein restriction, very low protein diet, low-protein diet, blood pressure control, hypertension, glomerular filtration rate decline, end-stage renal disease, proteinuria, renal failure, disease progression, mortality, renal function decline, end-stage renal disease prevention, mortality prevention
- MeSH terms
- Blood Pressure, Chronic Disease, Dietary Proteins, Female, Follow-Up Studies, Glomerular Filtration Rate, Humans, Hypertension, Kidney Diseases, Kidney Failure, Chronic, Polycystic Kidney Diseases, Male, Middle Aged, Linear Models
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