2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by LEVEY, A. S. Articles by KLAHR, S. Search for Related Content PubMed PubMed Citation Articles by LEVEY, A. S. Articles by KLAHR, S.

Dietary Protein Restriction and the Progression of Chronic Renal Disease

What Have All of the Results of the MDRD Study Shown?

National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland.

Correspondence to Dr. Andrew S. Levey, Division of Nephrology, New England Medical Center, Box 391, 750 Washington Street, Boston, MA 02111. Phone: 617-636-5898; Fax: 617-636-8329; E-mail: Andrew.Levey{at}es.nemc.org

Abstract

Abstract. The Modification of Diet in Renal Disease (MDRD) Study was the largest randomized clinical trial to test the hypothesis that protein restriction slows the progression of chronic renal disease. However, the primary results published in 1994 were not conclusive with regard to the efficacy of this intervention. Many physicians interpreted the failure of the MDRD Study to demonstrate a beneficial effect of protein restriction over a 2- to 3-yr period as proving that this therapy does not slow disease progression. The authors believe that this viewpoint is incorrect, and is the result of misinterpretation of inconclusive evidence as evidence in favor of the null hypothesis. Since then, numerous secondary analyses of the MDRD Study have been undertaken to clarify the effect of protein restriction on the rate of decline in GFR, urine protein excretion, and onset of end-stage renal disease. This review describes some of the principles of secondary analyses of randomized clinical trials, presents the results of these analyses from the MDRD Study, and compares them with results from other randomized clinical trials. Although these secondary results cannot be regarded as definitive, the authors conclude that the balance of evidence is more consistent with the hypothesis of a beneficial effect of protein restriction than with the contrary hypothesis of no beneficial effect. Until additional data become available, physicians must continue to make recommendations in the absence of conclusive results. The authors suggest that physicians incorporate the results of these secondary analyses into their interpretation of the findings of the MDRD Study.

This article has been cited by other articles:

				Authors/Task Force Members:, G. Mancia, G. De Backer, A. Dominiczak, R. Cifkova, R. Fagard, G. Germano, G. Grassi, A. M. Heagerty, S. E. Kjeldsen, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur. Heart J., June 11, 2007; (2007) ehm236v1. [Full Text] [PDF]

				T. Ali, I. Khan, W. Simpson, G. Prescott, J. Townend, W. Smith, and A. MacLeod Incidence and Outcomes in Acute Kidney Injury: A Comprehensive Population-Based Study J. Am. Soc. Nephrol., April 1, 2007; 18(4): 1292 - 1298. [Abstract] [Full Text] [PDF]

				R. A. Chudleigh, G. Dunseath, W. Evans, J. N. Harvey, P. Evans, R. Ollerton, and D. R. Owens How Reliable Is Estimation of Glomerular Filtration Rate at Diagnosis of Type 2 Diabetes? Diabetes Care, February 1, 2007; 30(2): 300 - 305. [Abstract] [Full Text] [PDF]

				J. Uribarri and K. R. Tuttle Advanced Glycation End Products and Nephrotoxicity of High-Protein Diets Clin. J. Am. Soc. Nephrol., November 1, 2006; 1(6): 1293 - 1299. [Abstract] [Full Text] [PDF]

				L. A. Stevens, T. Greene, and A. S. Levey Surrogate End Points for Clinical Trials of Kidney Disease Progression Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 874 - 884. [Full Text] [PDF]

				S. Sandhu, N. Wiebe, L. F. Fried, and M. Tonelli Statins for Improving Renal Outcomes: A Meta-Analysis J. Am. Soc. Nephrol., July 1, 2006; 17(7): 2006 - 2016. [Abstract] [Full Text] [PDF]

				W. Van Biesen, R. Vanholder, N. Veys, F. Verbeke, J. Delanghe, D. De Bacquer, and N. Lameire The importance of standardization of creatinine in the implementation of guidelines and recommendations for CKD: implications for CKD management programmes Nephrol. Dial. Transplant., January 1, 2006; 21(1): 77 - 83. [Abstract] [Full Text] [PDF]

				N. J. M. Cano, D. Fouque, and X. M. Leverve Application of Branched-Chain Amino Acids in Human Pathological States: Renal Failure J. Nutr., January 1, 2006; 136(1): 299S - 307S. [Abstract] [Full Text] [PDF]

				R. H. Stephens, P. McElduff, A. H. Heald, J. P. New, J. Worthington, W. E. Ollier, and J. M. Gibson Polymorphisms in IGF-Binding Protein 1 Are Associated With Impaired Renal Function in Type 2 Diabetes Diabetes, December 1, 2005; 54(12): 3547 - 3553. [Abstract] [Full Text] [PDF]

				P. K. Jacobsen Preventing end stage renal disease in diabetic patients -- genetic aspect (part I) Journal of Renin-Angiotensin-Aldosterone System, March 1, 2005; 6(1): 1 - 14. [Abstract] [PDF]

				V. A. Luyckx and T. A. Mardigan High protein diets may be hazardous for the kidneys Nephrol. Dial. Transplant., October 1, 2004; 19(10): 2678 - 2679. [Full Text] [PDF]

				S. C. Thomson, V. Vallon, and R. C. Blantz Kidney function in early diabetes: the tubular hypothesis of glomerular filtration Am J Physiol Renal Physiol, January 1, 2004; 286(1): F8 - F15. [Abstract] [Full Text] [PDF]

				P. Jacobsen, L. Tarnow, B. Carstensen, P. Hovind, O. Poirier, and H.-H. Parving Genetic Variation in the Renin-Angiotensin System and Progression of Diabetic Nephropathy J. Am. Soc. Nephrol., November 1, 2003; 14(11): 2843 - 2850. [Abstract] [Full Text] [PDF]

				H. T. Yu Progression of Chronic Renal Failure Arch Intern Med, June 23, 2003; 163(12): 1417 - 1429. [Abstract] [Full Text] [PDF]

				M. Tonelli, L. Moye, F. M. Sacks, T. Cole, and G. C. Curhan Effect of Pravastatin on Loss of Renal Function in People with Moderate Chronic Renal Insufficiency and Cardiovascular Disease J. Am. Soc. Nephrol., June 1, 2003; 14(6): 1605 - 1613. [Abstract] [Full Text] [PDF]

				R. Zatz, I. L. Noronha, and C. K. Fujihara Experimental and clinical rationale for use of MMF in nontransplant progressive nephropathies Am J Physiol Renal Physiol, December 1, 2002; 283(6): F1167 - F1175. [Abstract] [Full Text] [PDF]

				A. S. Levey Nondiabetic Kidney Disease N. Engl. J. Med., November 7, 2002; 347(19): 1505 - 1511. [Full Text] [PDF]

				C. Castaneda, P. L. Gordon, K. L. Uhlin, A. S. Levey, J. J. Kehayias, J. T. Dwyer, R. A. Fielding, R. Roubenoff, and M. F. Singh Resistance Training To Counteract the Catabolism of a Low-Protein Diet in Patients with Chronic Renal Insufficiency: A Randomized, Controlled Trial Ann Intern Med, December 4, 2001; 135(11): 965 - 976. [Abstract] [Full Text] [PDF]

				P. Ruggenenti, A. Perna, and G. Remuzzi ACE Inhibitors to Prevent End-Stage Renal Disease: When to Start and Why Possibly Never to Stop: A Post Hoc Analysis of the REIN Trial Results J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2832 - 2837. [Abstract] [Full Text] [PDF]

				D. J. Jenkins, C. W. Kendall, E. Vidgen, L. S. Augustin, M. van Erk, A. Geelen, T. Parker, D. Faulkner, V. Vuksan, R. G Josse, et al. High-protein diets in hyperlipidemia: effect of wheat gluten on serum lipids, uric acid, and renal function Am. J. Clinical Nutrition, July 1, 2001; 74(1): 57 - 63. [Abstract] [Full Text] [PDF]

				F. Locatelli, F. Valderrabano, N. Hoenich, J. Bommer, K. Leunissen, and V. Cambi The management of chronic renal insufficiency in the conservative phase Nephrol. Dial. Transplant., October 1, 2000; 15(10): 1529 - 1534. [Full Text] [PDF]

				L. A. Slomowitz, A. Deng, J. S. Hammes, F. Gabbai, and S. C. Thomson Glomerulotubular balance, dietary protein, and the renal response to glycine in diabetic rats Am J Physiol Regulatory Integrative Comp Physiol, April 1, 2002; 282(4): R1096 - R1103. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673