restricting protein intake and Controlling hypertension delay the progression of renal disease in animal.
We tested these interventions in 840 protein various chronic renal diseases.
Methods. In study 1, 585 patients with glomerular filtration rate during of 25 to 55 ml per minute per 1.73 m2 of body-surface area were randomly assigned to a usual-protein diet(1.3 or 0.58 g of protein per kilogram of body weight per day)
and to a usual- or a low group(P 0.07). There was no delay in the time to the blood pressure group(mean arterial pressure, 107 or occurrence of end-stage renal disease or death. In both 92 mm Hg). In study 2, 255 patients with glomerular studies, patients in the low-blood-pressure group who filtration rates of 13 to 24 ml per minute per 1.73 m had more pronounced proteinuria at base line had a sig were randomly assigned to the low-protein diet(0.58 g nificantly slower rate of decline in the glomerular filtra per kilogram per day) or a very-low-protein diet(0.28 tion rate Conclusions. Among patients with moderate renai in g per kilogram per day) with a keto acid-amino acid supplement, and a usual- or a low-blood-pressure group sufficiency, the slower decline in renal function that started(same values as those in study 1). An 18-to-45-month four months after the introduction of a low-protein diet sug follow-up was planned, with monthly evaluations of the gests a small benefit of this dietary intervention. Among patients patients with more severe renal insufficiency, a very low Results. The mean follow-up was 2.2 years. In study protein diet, as compared with a low-protein diet, did not 1, the projected mean decline in the glomerular filtration significantly slow the progression of renal disease. (N Engl rata at three years did not differ significantly between the
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