Fouque D, Laville M, Boissel J P
JE 2411 - Dénutrition des Maladies Chroniques, Département de Néphrologie, Hôpital Edouard HERRIOT, Lyon Cedex 03, France 69437.
Cochrane Database Syst Rev. 2006 Apr 19(2):CD001892. doi: 10.1002/14651858.CD001892.pub2.
For more than fifty years, low protein diets have been proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis have not been resolved.
To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis.
Cochrane Renal Group trials register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. Congress abstracts (American Society of Nephrology since 1990, European Dialysis Transplant Association since 1985, International Society of Nephrology since 1987). Direct contacts with investigators. Date of most recent search: December 2004.
Randomised trials comparing two different levels of protein intake in adult patients suffering from moderate to severe renal failure, followed for at least one year.
Two reviewers independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes with 95% confidence intervals (CI). Collection of the number of "renal deaths" defined as the need for starting dialysis, the death of a patient or a kidney transplant during the trial.
Eight trials were identified from over 40 studies. A total of 1524 patients were analysed, 763 had received reduced protein intake and 761 a higher protein intake. Two hundred and fifty one renal deaths were recorded, 103 in the low protein diet and 148 in the higher protein diet group (RR 0.69, 95% CI 0.56 to 0.86, P = 0.0007). To avoid one renal death, 2 to 56 patients need to be treated with a low protein diet during one year.
AUTHORS' CONCLUSIONS: Reducing protein intake in patients with chronic kidney disease reduces the occurrence of renal death by 31% as compared with higher or unrestricted protein intake. The optimal level of protein intake cannot be confirmed from these studies.
五十多年来，一直向肾衰竭患者推荐低蛋白饮食。然而，这些饮食在预防严重肾衰竭及维持性透析需求方面的效果尚未明确。
确定低蛋白饮食在延迟开始维持性透析需求方面的疗效。
考克兰肾脏组试验注册库、考克兰对照试验中心注册库、医学索引数据库及循证医学数据库。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）。与研究者直接联系。最近检索日期：2004年12月。
比较成年中重度肾衰竭患者两种不同蛋白质摄入量水平、随访至少一年的随机试验。
两名评价员独立选择研究并提取数据。采用随机效应模型进行统计分析，结果以二分类结局的相对危险度（RR）及95%置信区间（CI）表示。收集定义为开始透析需求、试验期间患者死亡或肾移植的“肾脏死亡”数量。
从40多项研究中确定了8项试验。共分析了1524例患者，763例接受了低蛋白摄入，761例接受了高蛋白摄入。记录了251例肾脏死亡，低蛋白饮食组103例，高蛋白饮食组148例（RR 0.69，95%CI 0.56至0.86，P = 0.0007）。为避免一例肾脏死亡，一年内需要2至56例患者接受低蛋白饮食治疗。
与高蛋白或无限制蛋白摄入相比，慢性肾病患者减少蛋白摄入可使肾脏死亡发生率降低31%。这些研究无法确定最佳蛋白摄入量水平。
