Fouque Denis, Laville Maurice
Département de Néphrologie, U870 INSERM-Université Claude Bernard Lyon 11, Hôpital Edouard Herriot, Lyon Cedex 03, France, 69437.
Cochrane Database Syst Rev. 2009 Jul 8(3):CD001892. doi: 10.1002/14651858.CD001892.pub3.
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 kidney 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 studies register, the Cochrane Central Register of Controlled studies, 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.
Randomised studies comparing two different levels of protein intake in adult patients suffering from moderate to severe kidney failure, followed for at least one year.
Two authors independently selected studies and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (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 study.
Ten studies were identified from over 40 studies. A total of 2000 patients were analysed, 1002 had received reduced protein intake and 998 a higher protein intake. There were 281 renal deaths recorded, 113 in the low protein diet and 168 in the higher protein diet group (RR 0.68, 95% CI 0.55 to 0.84, P = 0.0002). 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 32% 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和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缓开始维持性透析需求方面的疗效。
Cochrane肾脏研究组研究注册库、Cochrane对照试验中心注册库、医学期刊数据库（MEDLINE）和荷兰医学文摘数据库（EMBASE）。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。
比较中度至重度肾衰竭成年患者两种不同蛋白质摄入量水平的随机研究，随访至少一年。
两位作者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，结果以二分结局的风险比（RR）及95%置信区间（CI）表示。收集定义为开始透析需求、研究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10项研究。共分析了2000例患者，1002例接受了降低蛋白质摄入量，998例接受了较高蛋白质摄入量。记录到281例肾脏死亡，低蛋白饮食组113例，高蛋白饮食组168例（RR 0.68，95% CI 0.55至0.84，P = 0.0002）。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。
与较高或无限制蛋白质摄入量相比，慢性肾脏病患者减少蛋白质摄入量可使肾脏死亡发生率降低32%。这些研究无法确定最佳蛋白质摄入量水平。
