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Evidence summaries

Low Protein Diets for Chronic Kidney Disease in Non-Diabetic Adults

Very low protein diet appears to reduce the progress of chronic kidney disease stage 4 or 5 to end-stage kidney disease. However, it may not influence mortality. Level of evidence: "B"

Comment: The quality of evidence is downgraded by study limitations (open-label studies).

A Cochrane review [Abstract] 1 included 17 studies with a total of 2 996 subjects. Comparing low protein diet to normal diet, there was little or no difference in the numbers of participants who died or reached end-stage renal disease (ESKD) (table T1). A very low protein intake compared with a low protein intake made little or no difference to death. However, it reduced the number who reach ESKD (table T2).

Low protein diet versus normal protein diet

OutcomesRelative effect(95% CI)Risk with control - Normal protein dietRisk with intervention - Low protein diet (95% CI)No. of participants(studies) Certainty of the evidence
Death (all causes)RR 0.77(0.51 to 1.18)55 per 1 00042 per 1 000(28 to 65)1680 (5) Moderate
ESKDRR 1.05(0.73 to 1.53)144 per 1 000151 per 1 000(105 to 220)1814 (6) Low
End or change in GFR-The SMD for end or change in GFR was 0.18 lower (0.75 lower to 0.38 higher) with low protein diet compared to normal protein diet1680 (8) Very low

Very low protein diet versus normal protein diet

OutcomesRelative effect(95% CI)Risk with control - Normal or low protein dietRisk with intervention - Very low protein diet (95% CI)No. of participants(studies) Certainty of the evidence
Death (all causes)RR 1.26(0.62 to 2.54)39 per 1 00049 per 1 000(24 to 99)681 (6) Moderate
ESKDRR 0.64(0.49 to 0.85)458 per 1 000293 per 1 000(225 to 389)1010 (10) Moderate
End or change in GFR-The SMD for end or change in GFR was 0.12 (0.27 lower to 0.52 higher) with very low protein diet compared to low or normal protein diet456 (6) Low

    References

    • Hahn D, Hodson EM, Fouque D. Low protein diets for non-diabetic adults with chronic kidney disease. Cochrane Database Syst Rev 2020;(10):CD001892.[PubMed]

Primary/Secondary Keywords