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Restriction of dietary protein and progression of renal failure in diabetic nephropathy.
Lancet. 1989 Dec 16; 2(8677):1411-5.Lct

Abstract

In a study of the effect of a low-protein diet on the progression of renal disease 19 insulin-dependent diabetic patients with persistent clinical proteinuria were observed for 12-39 (mean 29) months while they were on a normal-protein diet (1.13 [0.06] g/kg per day), then for 12-49 (mean 33) months on a low-protein diet (0.67 [0.03] g/kg per day). The low-protein diet had no adverse effect on nutrition or glycosylated haemoglobin concentration. Mean supine blood pressure (BP) fell slightly on the low-protein diet and was probably due to the start or modification of antihypertensive medication in 9 patients. The mean rate of decline in glomerular filtration rate fell from 0.61 (SEM 0.14) ml/min per month with the normal-protein diet to 0.14 (0.08) with the low-protein diet, and this effect remained highly significant after adjustment for blood pressure, energy intake, and glycosylated haemoglobin. The rise in the fractional clearance of albumin during a normal-protein diet stopped with the low-protein diet, and there was a significant fall in albumin excretion from 467 (95% CI 234-895) micrograms/24 h on the normal-protein to 340 (138-719) on the low-protein diet. Thus, a low-protein diet, with its reduction in protein and possibly other dietary components such as phosphate or fat, seems to retard the rate of decline of glomerular filtration rate in diabetic nephropathy independently of blood pressure changes and glycaemic control.

Authors+Show Affiliations

Walker JD
Unit for Metabolic Medicine, UMDS Guy's Campus, Guy's Hospital, London.
Bending JJ
No affiliation info available
Dodds RA
No affiliation info available
Mattock MB
No affiliation info available
Murrells TJ
No affiliation info available
Keen H
No affiliation info available
Viberti GC
No affiliation info available

MeSH

AdultAntihypertensive AgentsBlood PressureClinical Trials as TopicDiabetes Mellitus, Type 1Diabetic NephropathiesDietary ProteinsEvaluation Studies as TopicFollow-Up StudiesGlomerular Filtration RateHumansMiddle AgedProspective StudiesProteinuriaSerum Albumin

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

2574360

Citation

Walker, J D., et al. "Restriction of Dietary Protein and Progression of Renal Failure in Diabetic Nephropathy." Lancet (London, England), vol. 2, no. 8677, 1989, pp. 1411-5.
Walker JD, Bending JJ, Dodds RA, et al. Restriction of dietary protein and progression of renal failure in diabetic nephropathy. Lancet. 1989;2(8677):1411-5.
Walker, J. D., Bending, J. J., Dodds, R. A., Mattock, M. B., Murrells, T. J., Keen, H., & Viberti, G. C. (1989). Restriction of dietary protein and progression of renal failure in diabetic nephropathy. Lancet (London, England), 2(8677), 1411-5.
Walker JD, et al. Restriction of Dietary Protein and Progression of Renal Failure in Diabetic Nephropathy. Lancet. 1989 Dec 16;2(8677):1411-5. PubMed PMID: 2574360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restriction of dietary protein and progression of renal failure in diabetic nephropathy. AU - Walker,J D, AU - Bending,J J, AU - Dodds,R A, AU - Mattock,M B, AU - Murrells,T J, AU - Keen,H, AU - Viberti,G C, PY - 1989/12/16/pubmed PY - 1989/12/16/medline PY - 1989/12/16/entrez SP - 1411 EP - 5 JF - Lancet (London, England) JO - Lancet VL - 2 IS - 8677 N2 - In a study of the effect of a low-protein diet on the progression of renal disease 19 insulin-dependent diabetic patients with persistent clinical proteinuria were observed for 12-39 (mean 29) months while they were on a normal-protein diet (1.13 [0.06] g/kg per day), then for 12-49 (mean 33) months on a low-protein diet (0.67 [0.03] g/kg per day). The low-protein diet had no adverse effect on nutrition or glycosylated haemoglobin concentration. Mean supine blood pressure (BP) fell slightly on the low-protein diet and was probably due to the start or modification of antihypertensive medication in 9 patients. The mean rate of decline in glomerular filtration rate fell from 0.61 (SEM 0.14) ml/min per month with the normal-protein diet to 0.14 (0.08) with the low-protein diet, and this effect remained highly significant after adjustment for blood pressure, energy intake, and glycosylated haemoglobin. The rise in the fractional clearance of albumin during a normal-protein diet stopped with the low-protein diet, and there was a significant fall in albumin excretion from 467 (95% CI 234-895) micrograms/24 h on the normal-protein to 340 (138-719) on the low-protein diet. Thus, a low-protein diet, with its reduction in protein and possibly other dietary components such as phosphate or fat, seems to retard the rate of decline of glomerular filtration rate in diabetic nephropathy independently of blood pressure changes and glycaemic control. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/2574360/Restriction_of_dietary_protein_and_progression_of_renal_failure_in_diabetic_nephropathy_ DB - PRIME DP - Unbound Medicine ER -