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Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study.
Am J Kidney Dis. 2009 Feb; 53(2):208-17.AJ

Abstract

BACKGROUND

The long-term effect of a very low-protein diet on the progression of kidney disease is unknown. We examined the effect of a very low-protein diet on the development of kidney failure and death during long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study.

STUDY DESIGN

Long-term follow-up of study B of the MDRD Study (1989-1993).

SETTING & PARTICIPANTS

The MDRD Study examined the effects of dietary protein restriction and blood pressure control on progression of kidney disease. This analysis includes 255 trial participants with predominantly stage 4 nondiabetic chronic kidney disease.

INTERVENTION

A low-protein diet (0.58 g/kg/d) versus a very low-protein diet (0.28 g/kg/d) supplemented with a mixture of essential keto acids and amino acids (0.28 g/kg/d).

OUTCOMES

Kidney failure (initiation of dialysis therapy or transplantation) and all-cause mortality until December 31, 2000.

RESULTS

Kidney failure developed in 227 (89%) participants, 79 (30.9%) died, and 244 (95.7%) reached the composite outcome of either kidney failure or death. Median duration of follow-up until kidney failure, death, or administrative censoring was 3.2 years, and median time to death was 10.6 years. In the low-protein group, 117 (90.7%) participants developed kidney failure, 30 (23.3%) died, and 124 (96.1%) reached the composite outcome. In the very low-protein group, 110 (87.3%) participants developed kidney failure, 49 (38.9%) died, and 120 (95.2%) reached the composite outcome. After adjustment for a priori-specified covariates, hazard ratios were 0.83 (95% confidence interval, 0.62 to 1.12) for kidney failure, 1.92 (95% confidence interval, 1.15 to 3.20) for death, and 0.89 (95% confidence interval, 0.67 to 1.18) for the composite outcome in the very low-protein diet group compared with the low-protein diet group.

LIMITATIONS

Lack of dietary protein measurements during follow-up.

CONCLUSION

In long-term follow-up of the MDRD Study, assignment to a very low-protein diet did not delay progression to kidney failure, but appeared to increase the risk of death.

Links

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Authors+Show Affiliations

Menon V
Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
Kopple JD
No affiliation info available
Wang X
No affiliation info available
Beck GJ
No affiliation info available
Collins AJ
No affiliation info available
Kusek JW
No affiliation info available
Greene T
No affiliation info available
Levey AS
No affiliation info available
Sarnak MJ
No affiliation info available

MeSH

AdultAmino AcidsChronic DiseaseDiet, Protein-RestrictedDietary SupplementsDisease ProgressionFemaleFollow-Up StudiesHumansKeto AcidsKidney DiseasesMaleRandomized Controlled Trials as TopicRenal InsufficiencySurvival Analysis

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

18950911

Citation

Menon, Vandana, et al. "Effect of a Very Low-protein Diet On Outcomes: Long-term Follow-up of the Modification of Diet in Renal Disease (MDRD) Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 2, 2009, pp. 208-17.
Menon V, Kopple JD, Wang X, et al. Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis. 2009;53(2):208-17.
Menon, V., Kopple, J. D., Wang, X., Beck, G. J., Collins, A. J., Kusek, J. W., Greene, T., Levey, A. S., & Sarnak, M. J. (2009). Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(2), 208-17. https://doi.org/10.1053/j.ajkd.2008.08.009
Menon V, et al. Effect of a Very Low-protein Diet On Outcomes: Long-term Follow-up of the Modification of Diet in Renal Disease (MDRD) Study. Am J Kidney Dis. 2009;53(2):208-17. PubMed PMID: 18950911.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of a very low-protein diet on outcomes: long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. AU - Menon,Vandana, AU - Kopple,Joel D, AU - Wang,Xuelei, AU - Beck,Gerald J, AU - Collins,Allan J, AU - Kusek,John W, AU - Greene,Tom, AU - Levey,Andrew S, AU - Sarnak,Mark J, Y1 - 2008/10/31/ PY - 2008/02/28/received PY - 2008/08/07/accepted PY - 2008/10/28/pubmed PY - 2009/2/12/medline PY - 2008/10/28/entrez SP - 208 EP - 17 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 2 N2 - BACKGROUND: The long-term effect of a very low-protein diet on the progression of kidney disease is unknown. We examined the effect of a very low-protein diet on the development of kidney failure and death during long-term follow-up of the Modification of Diet in Renal Disease (MDRD) Study. STUDY DESIGN: Long-term follow-up of study B of the MDRD Study (1989-1993). SETTING & PARTICIPANTS: The MDRD Study examined the effects of dietary protein restriction and blood pressure control on progression of kidney disease. This analysis includes 255 trial participants with predominantly stage 4 nondiabetic chronic kidney disease. INTERVENTION: A low-protein diet (0.58 g/kg/d) versus a very low-protein diet (0.28 g/kg/d) supplemented with a mixture of essential keto acids and amino acids (0.28 g/kg/d). OUTCOMES: Kidney failure (initiation of dialysis therapy or transplantation) and all-cause mortality until December 31, 2000. RESULTS: Kidney failure developed in 227 (89%) participants, 79 (30.9%) died, and 244 (95.7%) reached the composite outcome of either kidney failure or death. Median duration of follow-up until kidney failure, death, or administrative censoring was 3.2 years, and median time to death was 10.6 years. In the low-protein group, 117 (90.7%) participants developed kidney failure, 30 (23.3%) died, and 124 (96.1%) reached the composite outcome. In the very low-protein group, 110 (87.3%) participants developed kidney failure, 49 (38.9%) died, and 120 (95.2%) reached the composite outcome. After adjustment for a priori-specified covariates, hazard ratios were 0.83 (95% confidence interval, 0.62 to 1.12) for kidney failure, 1.92 (95% confidence interval, 1.15 to 3.20) for death, and 0.89 (95% confidence interval, 0.67 to 1.18) for the composite outcome in the very low-protein diet group compared with the low-protein diet group. LIMITATIONS: Lack of dietary protein measurements during follow-up. CONCLUSION: In long-term follow-up of the MDRD Study, assignment to a very low-protein diet did not delay progression to kidney failure, but appeared to increase the risk of death. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18950911/Effect_of_a_very_low_protein_diet_on_outcomes:_long_term_follow_up_of_the_Modification_of_Diet_in_Renal_Disease__MDRD__Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)01297-3 DB - PRIME DP - Unbound Medicine ER -