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Meta-Analysis
. 2007 Oct 17;2007(4):CD006863.
doi: 10.1002/14651858.CD006863.

Protein restriction for children with chronic renal failure

S Chaturvedi  1 , C Jones
Affiliations
Meta-Analysis

Protein restriction for children with chronic renal failure

S Chaturvedi et al. Cochrane Database Syst Rev. .

Abstract

Background: Protein restriction has been prescribed for some time for patients with chronic kidney disease (CKD). The effect of a low protein diet on delaying the progression to end-stage kidney disease (ESKD) in children and its impact on growth and nutrition remains unresolved.

Objectives: To determine the efficacy of protein restricted diet in delaying the start of maintenance dialysis and maintaining nutrition in children.

Search strategy: Cochrane Renal group trials register, the Cochrane Central register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of nephrology textbooks, review articles and relevant trials.

Selection criteria: Randomised control trials (RCTs) comparing un-restricted protein diet versus a protein restricted diet (to safe amounts recommended by WHO), with follow-up period of at least six months were included.

Data collection and analysis: Two authors independently selected studies. Statistical analysis were performed using the random effects model. For dichotomous outcome results are expressed as relative risk (RR) with 95% confidence intervals (CI). Where continuous scales of measurement are used to assess the effects of treatment, the mean difference (WMD) was used.

Main results: Two studies (250 children) were identified, 124 received a protein restricted diet and 126 a control diet. No significant differences was found in the number of renal deaths (RR 1.12, 95% CI 0.54 to 2.33), progression of kidney disease (creatinine clearance at two years: WMD 1.47, 95% CI -1.19 to 4.14) or growth (weight - WMD -0.13, 95% CI -1.10 to 0.84; height - WMD -1.99, 95% CI -4.84 to 0.86).

Authors' conclusions: Reducing protein intake does not appear to have significant impact in delaying the progression to ESKD in children.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 1 Renal death.
1.2
1.2. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 2 Creatinine clearance (mL/min/1.73 m²) at 2 years (change scores).
1.3
1.3. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 3 Creatinine clearance (mL/min/1.73 m²) at 3 years (change scores).
1.4
1.4. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 4 Proteinuria at 2 years (mg/kg/d).
1.5
1.5. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 5 Proteinuria at 3 years (mg/kg/d).
1.6
1.6. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 6 Systolic blood pressure at 2 years (mm Hg).
1.7
1.7. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 7 Diastolic blood pressure at 2 years (mm Hg).
1.8
1.8. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 8 Systolic blood pressure at 3 years (mm Hg).
1.9
1.9. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 9 Diastolic blood pressure at 3 years (mm Hg).
1.10
1.10. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 10 Weight.
1.11
1.11. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 11 Height (cm).
1.12
1.12. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 12 Upper arm circumference (standard deviation score for chronological age).
1.13
1.13. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 13 Triceps skin fold thickness (centiles).
1.14
1.14. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 14 Serum albumin (g/L).
1.15
1.15. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 15 Serum transferrin (g/L).
1.16
1.16. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 16 Serum cholesterol (mmol/L).
1.17
1.17. Analysis
Comparison 1 Protein restricted diet versus control, Outcome 17 Serum triglyceride (mmol/L).
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