Protein restriction for children with chronic renal failure

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. Copyright © 2008 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.