Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood.
Background: Some studies have suggested that a low-protein diet slows the deterioration of renal function in patients with chronic renal failure (CRF). The effects of a low-protein diet on renal function and growth, have not been assessed in a large, prospective randomised trial in children with CRF...
| Publicado en: | Lancet Vol. 349; no. 9059; pp. 1117 - 1124 |
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| Autores principales: | , , , , , , , |
| Formato: | clinical trial research tables/charts Journal Article |
| Publicado: |
Lancet
4/19/1997
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107271924&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 107271924 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 4/19/1997 vid: 349 iid: 9059 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 107271924 107271924 NLM9113009 1998042330 10.1016/s0140-6736(96)09260-4 NLM9113009 107271924 ppf: 1117 ppct: 7 formats: fmt: @attributes: type: T tig: atl: Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. aug: au: Wingen A Fabian-Bach C Schaefer F Mehls O Wingen, A M Fabian-Bach, C Schaefer, F Mehls, O affil: University Children's Hospital, Heidelberg, Germany sug: subj: Restricted Diet Dietary Proteins Kidney Failure, Chronic Diet Therapy Child Child, Preschool Adolescence Prospective Studies Glomerular Filtration Rate Proteinuria Urinalysis Blood Pressure Creatinine Metabolism Body Weights and Measures Growth Diet Records Regression Life Table Method Treatment Outcomes Survival Analysis Kaplan-Meier Estimator Analysis of Variance Pearson's Correlation Coefficient Cox Proportional Hazards Model Clinical Trials Human Child: 6-12 years Child, Preschool: 2-5 years Adolescent: 13-18 years ab: Background: Some studies have suggested that a low-protein diet slows the deterioration of renal function in patients with chronic renal failure (CRF). The effects of a low-protein diet on renal function and growth, have not been assessed in a large, prospective randomised trial in children with CRF.Methods: A 2-year prospective, stratified, and randomised multicentre study recruited 191 patients aged 2-18 years. After a run-in period of at least 6 months, patients were stratified into either a progressive or non-progressive category based on the change in creatinine clearance in this period. The patients were also stratified into three renal-disease categories and then randomly assigned to a control or diet group. In the diet group, the protein intake was the lowest, safe WHO recommendation--i.e., 0.8-1.1 g/kg daily adjusted for age. All patients were advised to have a calorie intake of at least 70% of the WHO recommendations. Glomerular filtration rate (GFR) was measured every 2 months by creatinine clearance; dietary compliance was checked by urinary urea-nitrogen excretion and dietary diaries (weighing method). 112 patients completed an optional third year of the study.Findings: The low-protein diet did not affect growth. However, there was no effect of diet on the mean decline in creatinine clearance over 2 years (diet vs control: progressive group -9.7 [SD 8.0] vs -10.7 [11.8] mL/min per 1.73 m2; non-progressive group -2.5 [7.5] vs -4.3 [10.0] mL/min per 1.73 m2). Patients classified as having progressive disease were older and had a lower creatinine clearance and a higher blood pressure at randomisation, and had a greater decrease in creatinine clearance than non-progressive patients. On multivariate regression analysis proteinuria (partial R2 = 0.259) and systolic blood pressure (partial R2 = 0.087) were independent predictors of the change in GFR. Similar results were found after the study was extended for a third year.Interpretation: A low-protein diet for 3 years did not affect the decrease in renal function in children with CRF. Proteinuria and blood pressure explain a large part of the variability of, and may be causally related to the decline in the GFR. pubtype: Academic Journal doctype: clinical trial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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