Nutritional support in chronic renal failure: systematic review.
OBJECTIVE
The purpose of this systematic review was to locate and assess in patients with chronic renal disease the quality of scientific evidence to establish graded recommendations based on the efficacy and effectiveness of nutritional support.


METHODS
Computerized and online versions of MEDLINE (from 1989 through March 1999) and EMBASE (from 1988 through January 1999) were consulted. The Cochrane Library and the online Healthstar (from 1975) databases were also searched for clinical trials. A total of 593 studies were assessed. Following methodological review (primary reviewer), only 45 studies reviewed met criteria for selection and were analyzed by a group of experts (secondary reviewer). A final consensus was reached between the co-ordinators, experts and methodologists.


CONCLUSIONS
Low and very low-protein diets associated with specific enteral supplements are indicated in most patients with chronic renal disease and in patients with incipient diabetic nephropathy to slow progression of disease and to improve their overall status, contributing to improved survival (grade A recommendation). The use of protein-restricted diets in diabetic nephropathy is only indicated in type I diabetes mellitus (grade A recommendation). An improvement in nutritional parameters was found when specific diets were given in chronic renal disease (grade C recommendation).
Zarazaga
A
A
Department of Surgery, Hospital Universitario La Paz, Madrid, Spain.
García-De-Lorenzo
L
L
García-Luna
P P
PP
García-Peris
P
P
López-Martínez
J
J
Lorenzo
V
V
Quecedo
L
L
Del Llano
J
J
D002908:Chronic Disease; D018849:Controlled Clinical Trials as Topic; D003928:Diabetic Nephropathies / Q000628:therapy*; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage*; D018450:Disease Progression; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016239:MEDLINE; D009752:Nutritional Status; D018529:Nutritional Support / Q000592:standards*; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D004044:Dietary Proteins