Fouque D, Wang P, Laville M, Boissel J P
Department of Nephrology, Cochrane Renal Group, Hôpital Edouard Herriot, Lyon, France.
Nephrol Dial Transplant. 2000 Dec;15(12):1986-92. doi: 10.1093/ndt/15.12.1986.
The objective of this study was to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis based on an analysis of published literature.
The search strategy involved a Medline and Embase search from January 1966 through to June 1999, congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987) and direct contacts with investigators. The selection criteria included randomized trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least 1 year. Patients with diabetic nephropathy were excluded. Seven trials were selected from 40 studies since 1975. A total of 1494 patients were analysed: 753 had received reduced protein intake and 741 a higher protein intake. The numbers of 'renal deaths' (defined as the need for starting dialysis, the death of a patient or kidney transplant during the trial) were collected.
242 renal deaths were recorded, 101 in the low protein diet and 141 in the higher protein diet group, giving an odds ratio of 0.61 with a 95% confidence interval of 0.46 to 0.83 (P=0.006).
Reducing protein intake in patients with chronic renal failure reduces the occurrence of renal death by about 40% as compared with larger or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.
本研究的目的是基于对已发表文献的分析，确定低蛋白饮食在延迟开始维持性透析需求方面的疗效。
检索策略包括1966年1月至1999年6月的Medline和Embase检索、会议摘要（自1990年起的美国肾脏病学会、自1985年起的欧洲透析移植协会、自1987年起的国际肾脏病学会）以及与研究者的直接联系。选择标准包括比较成年中重度肾衰竭患者两种不同蛋白质摄入量水平的随机试验，随访至少1年。排除糖尿病肾病患者。从1975年以来的40项研究中选取了7项试验。共分析了1494例患者：753例接受了降低的蛋白质摄入量，741例接受了较高的蛋白质摄入量。收集了“肾脏死亡”（定义为在试验期间需要开始透析、患者死亡或进行肾移植）的数量。
记录了242例肾脏死亡，低蛋白饮食组101例，高蛋白饮食组141例，优势比为0.61，95%置信区间为0.46至0.83（P = 0.006）。
与摄入较多或无限制蛋白质相比，慢性肾衰竭患者减少蛋白质摄入量可使肾脏死亡的发生率降低约40%。这些研究无法确定蛋白质摄入的最佳水平。
