(24-09-08) Low-protein diet for diabetic nephropathy: a meta-analysis of randomized controlled trials1,2,3

Yu Pan, Li Li Guo and Hui Min Jin

1 From the Division of Nephrology, No. 3 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (YP and HMJ), and the Hemodialysis Center, Bao Shan Branch of No. 1 People's Hospital, Shanghai Jiao Tong University, Shanghai, China (LLG)
Background: A low-protein diet (LPD) has been proposed for many years to delay the progression of diabetic nephropathy. However, the efficacy of an LPD with respect to renal outcome is disputed.
Objective: We aimed to determine the effect of an LPD on renal function in patients with type 1 or 2 diabetic renal diseases by using a meta-analysis of randomized controlled trials.
Design: Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. Eight studies met the inclusion criteria for our meta-analysis: a duration of >6 mo, use of a randomized control group, availability of outcome data for changes in glomerular filtration rate (GFR) or creatinine clearance rate (CCR), and albuminuria or proteinuria in patients with type 1 or 2 diabetic nephropathy. Data were combined by means of a fixed-effects model. Weighted mean differences (WMD) were calculated for the change in GFR or CCR, glycated hemoglobin (HbA1c), and serum albumin between the LPD and control groups. A random-effects model was also used to calculate the standardized mean difference for the change in urinary albumin excretion or proteinuria.
Results: Overall, a change in WMD for GFR or CCR was not significantly associated with an LPD, but a decrease in WMD for HbA1c was significant in the LPD group (P = 0.005). Although the benefit of LPD therapy on proteinuria was significant (P = 0.003), great heterogeneity was observed. In a subgroup analysis, LPD resulted in lower serum albumin concentrations.
Conclusion: LPD was not associated with a significant improvement of renal function in patients with either types 1 or 2 diabetic nephropathy.

Source: American Journal of Clinical Nutrition, Vol. 88, No. 3, 660-666, September 2008

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