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Volume 330:877-884 March 31, 1994 Number 13 Next

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ABSTRACT

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.

Source Information

From the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md. (J.W.K., G.S.); Washington University Medical Center, St. Louis (S.K.); New England Medical Center, Boston (A.S.L.); the Cleveland Clinic Foundation, Cleveland (G.J.B.); the University of Pittsburgh, Pittsburgh (A.W.C.); and the University of Iowa Hospitals and Clinics, Iowa City (L.H.). The institutions and investigators participating in the study group are listed in the Appendix.

Address reprint requests to the MDRD Study Data Coordinating Center, Department of Biostatistics and Epidemiology, P88, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195.

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