Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus

Article Abstract:

Evidence exists that shows dietary changes could be beneficial in preventing a common complication of type I (insulin-dependent) diabetes mellitus, end-stage renal disease (kidney disease so severe that the kidneys no longer function). In particular, diets with restricted protein and phosphorus have been shown to slow the rate of progression of chronic renal failure. However, clinical studies have been largely uncontrolled and retrospective. To explore this issue in a randomized, controlled study, 35 diabetic patients with signs of kidney and retinal disease were assigned to either a low-protein, low-phosphorus diet (20 patients) or the continuation of their pre-study diet (15). Patients' renal function, blood pressure, blood sugar levels (glycemic control), and nutritional status were evaluated at regular intervals during the study, which followed patients, on average, for just under 35 months, with a minimum follow-up of 12 months. Results showed that the rate of progress of renal failure was substantially reduced for patients on the low-protein diet, as indicated by changes in their rates of creatinine and iothalamate clearance (two measures of kidney efficiency). Both groups continued to have good blood pressure and glycemic control, and the diet did not affect cholesterol or triglyceride levels, which is important since cardiovascular disease, associated with high blood cholesterol, is the other main cause of death in Type I diabetics besides renal disease. A discussion is presented of the physiological effects of the low-protein diet. The effectiveness of the diet in slowing the progression to renal failure in Type I diabetics is such that it should be recommended for a broad group of patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Complications and side effects, Phosphates, Type 1 diabetes

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The effect of protein restriction on the progression of renal insufficiency

Article Abstract:

Patients with chronic renal insufficiency, whose kidneys are not adequately excreting wastes, usually progress to end-stage renal failure, where their kidneys do not function at all. To determine whether the rate of progression was slowed by limiting the amount of protein in the patient's diet, 64 patients were studied who had moderate to severe renal insufficiency due to a number of renal diseases such as glomerulonephritis, tubulointerstitial nephropathy, and polycystic kidney disease lasting 18 months. The amount of protein given to the test group was approximately half that for a control group. The amount of calories ingested was the same for both the test and control groups, although the calories in the test group were from carbohydrates and fats. Levels of creatinine, a by-product of metabolism, and the rate of filtration of the glomerulus, the filtering unit of the kidney, were used to measure the rate of progression. Renal failure developed in nine out of 33 (27 percent) of the patients on the regular diet, while only two out of 31 (six percent) of the patients on the protein-restricted diet developed renal failure. Therefore, chronic renal disease can be slowed by restricting the amount of protein ingested by patients with chronic renal insufficiency without producing nutritional deficiencies. The mechanisms of the delay of renal failure are currently being studied.

Kidney diseases

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Efficacy and safety of benazepril for advanced chronic renal insufficiency

Article Abstract:

The efficacy and safety of benazepril in patients without diabetes who had advanced renal insufficiency is assessed. The results conclude that benazepril conferred substantial renal benefits in patients without diabetes who had advanced renal insufficiency.

Drug therapy, Diabetes, Diabetes mellitus, Dosage and administration, Kidney failure, Benazepril

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