Adequate protein dietary restriction in diabetic and nondiabetic patients with chronic renal failure.
OBJECTIVE
To evaluate whether a dietary protein restriction is useful for slowing the progression of chronic renal failure (CRF) in diabetic and nondiabetic patients and to analyze the possible risk of malnutrition after such a dietary regimen.


METHODS
Prospective, randomized case-control clinical trial.


METHODS
Nephrology outpatients.


METHODS
A total of 169 patients, 89 affected with CRF and chronic hypertension and 80 affected with overt diabetic nephropathy (24 suffering from type 1 and 56 from type 2 diabetes) and chronic hypertension.


METHODS
Diabetic patients and nondiabetic patients were randomly divided into 2 groups: 40 diabetic patients received a low-protein diet (0.8 g/kg/day) and 40 were maintained on a free protein diet; similarly, 44 nondiabetic patients received a low-protein diet (0.6 g/kg/day) and 45 were maintained on a free protein diet. The investigation lasted 1 year.


METHODS
Renal function and nutritional status.


RESULTS
At the end of the study, there were no statistically significant differences in renal function between treated and nontreated diabetic patients, whereas treated nondiabetic patients showed a lower decrease in renal function compared with the nontreated group. In both diabetic and nondiabetic patients, the mean body weight and obesity index decreased significantly in treated patients compared with nontreated ones. Serum albumin and prealbumin were stable in all patients during the whole study time, and there were no other signs of malnutrition.


CONCLUSIONS
An adequate dietary protein restriction is accepted by patients, and it is well tolerated during a 12-month follow-up. Without any sign of malnutrition, it is possible to get near the ideal body weight and to reduce the obesity index and the body mass index, which are both well-established risk factors for developing cardiovascular pathology. In nondiabetic patients only, we observed a significant slowing of the progression of renal damage.
Nephrology and Dialysis Unit, S. Eugenio Hospital, Rome, Italy. jumel@tin.it
Carlo
C
Meloni
Paola
P
Tatangelo
Silvia
S
Cipriani
Valeria
V
Rossi
Concetta
C
Suraci
Carmela
C
Tozzo
Bernardo
B
Rossini
Annalisa
A
Cecilia
Damiano
D
Di Franco
Emilia
E
Straccialano
Carlo U
CU
Casciani
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000178:diet therapy*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003928:Diabetic Nephropathies / Q000150:complications; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D002149:Energy Intake; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000178:diet therapy* / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000209:etiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011228:Prealbumin / Q000032:analysis; D011446:Prospective Studies; D012709:Serum Albumin / Q000032:analysis
D011228:Prealbumin; D012709:Serum Albumin