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Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study.
Kidney Int. 1997 Sep; 52(3):778-91.KI

Abstract

The safety of dietary protein and phosphorous restriction was evaluated in the Modification of Diet in Renal Disease (MDRD) Study. In Study A, 585 patients with a glomerular filtration rate (GFR) of 25 to 55 ml/min/1.73 m2 were randomly assigned to a usual-protein diet (1.3 g/kg/day) or a low-protein diet (0.58 g/kg/day). In Study B, 255 patients with a GFR of 13 to 24 ml/min/1.73 m2 were randomly assigned to the low-protein diet or a very-low-protein diet (0.28 g/kg/day), supplemented with a ketoacid-amino acid mixture (0.28 g/kg/day). The low-protein and very-low-protein diets were also low in phosphorus. Mean duration of follow-up was 2.2 years in both studies. Protein and energy intakes were lower in the low-protein and very-low-protein diet groups than in the usual-protein group. Two patients in Study B reached a "stop point" for malnutrition. There was no difference between randomized groups in the rates of death, first hospitalizations, or other "stop points" in either study. Mean values for various indices of nutritional status remained within the normal range during follow-up in each diet group. However, there were small but significant changes from baseline in some nutritional indices, and differences between the randomized groups in some of these changes. In the low-protein and very-low-protein diet groups, serum albumin rose, while serum transferrin, body wt, percent body fat, arm muscle area and urine creatinine excretion declined. Combining patients in both diet groups in each study, a lower achieved protein intake (from food and supplement) was not correlated with a higher rate of death, hospitalization or stop points, or with a progressive decline in any of the indices of nutritional status after controlling for baseline nutritional status and follow-up energy intake. These analyses suggest that the low-protein and very-low-protein diets used in the MDRD Study are safe for periods of two to three years. Nonetheless, both protein and energy intake declined and there were small but significant declines in various indices of nutritional status. These declines are of concern because of the adverse effect of protein calorie malnutrition in patients with end-stage renal disease. Physicians who prescribe low-protein diets must carefully monitor patients' protein and energy intake and nutritional status.

Authors+Show Affiliations

National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA. Andrew.Levey@es.nemc.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9291200

Citation

Kopple, J D., et al. "Effect of Dietary Protein Restriction On Nutritional Status in the Modification of Diet in Renal Disease Study." Kidney International, vol. 52, no. 3, 1997, pp. 778-91.
Kopple JD, Levey AS, Greene T, et al. Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;52(3):778-91.
Kopple, J. D., Levey, A. S., Greene, T., Chumlea, W. C., Gassman, J. J., Hollinger, D. L., Maroni, B. J., Merrill, D., Scherch, L. K., Schulman, G., Wang, S. R., & Zimmer, G. S. (1997). Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study. Kidney International, 52(3), 778-91.
Kopple JD, et al. Effect of Dietary Protein Restriction On Nutritional Status in the Modification of Diet in Renal Disease Study. Kidney Int. 1997;52(3):778-91. PubMed PMID: 9291200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of dietary protein restriction on nutritional status in the Modification of Diet in Renal Disease Study. AU - Kopple,J D, AU - Levey,A S, AU - Greene,T, AU - Chumlea,W C, AU - Gassman,J J, AU - Hollinger,D L, AU - Maroni,B J, AU - Merrill,D, AU - Scherch,L K, AU - Schulman,G, AU - Wang,S R, AU - Zimmer,G S, PY - 1997/9/18/pubmed PY - 1997/9/18/medline PY - 1997/9/18/entrez SP - 778 EP - 91 JF - Kidney international JO - Kidney Int VL - 52 IS - 3 N2 - The safety of dietary protein and phosphorous restriction was evaluated in the Modification of Diet in Renal Disease (MDRD) Study. In Study A, 585 patients with a glomerular filtration rate (GFR) of 25 to 55 ml/min/1.73 m2 were randomly assigned to a usual-protein diet (1.3 g/kg/day) or a low-protein diet (0.58 g/kg/day). In Study B, 255 patients with a GFR of 13 to 24 ml/min/1.73 m2 were randomly assigned to the low-protein diet or a very-low-protein diet (0.28 g/kg/day), supplemented with a ketoacid-amino acid mixture (0.28 g/kg/day). The low-protein and very-low-protein diets were also low in phosphorus. Mean duration of follow-up was 2.2 years in both studies. Protein and energy intakes were lower in the low-protein and very-low-protein diet groups than in the usual-protein group. Two patients in Study B reached a "stop point" for malnutrition. There was no difference between randomized groups in the rates of death, first hospitalizations, or other "stop points" in either study. Mean values for various indices of nutritional status remained within the normal range during follow-up in each diet group. However, there were small but significant changes from baseline in some nutritional indices, and differences between the randomized groups in some of these changes. In the low-protein and very-low-protein diet groups, serum albumin rose, while serum transferrin, body wt, percent body fat, arm muscle area and urine creatinine excretion declined. Combining patients in both diet groups in each study, a lower achieved protein intake (from food and supplement) was not correlated with a higher rate of death, hospitalization or stop points, or with a progressive decline in any of the indices of nutritional status after controlling for baseline nutritional status and follow-up energy intake. These analyses suggest that the low-protein and very-low-protein diets used in the MDRD Study are safe for periods of two to three years. Nonetheless, both protein and energy intake declined and there were small but significant declines in various indices of nutritional status. These declines are of concern because of the adverse effect of protein calorie malnutrition in patients with end-stage renal disease. Physicians who prescribe low-protein diets must carefully monitor patients' protein and energy intake and nutritional status. SN - 0085-2538 UR - https://www.unboundmedicine.com/medline/citation/9291200/Effect_of_dietary_protein_restriction_on_nutritional_status_in_the_Modification_of_Diet_in_Renal_Disease_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0085-2538(15)60235-6 DB - PRIME DP - Unbound Medicine ER -