Effect of dietary protein restriction on the progression of kidney disease: Long-term follow-up of the Modification of Diet in Renal Disease (MDRD) study
Effect of dietary protein restriction on the progression of kidney disease: Long-term follow-up of the Modification of Diet in Renal Disease (MDRD) study
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DOI：
10.1053/j.ajkd.2006.08.023
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发表时间：
2006-12-01
影响因子：
13.2
通讯作者：
Kopple, Joel D.
中科院分区：
文献类型：
--
作者：
Levey, Andrew S.;Greene, Tom;Kopple, Joel D.
背景 低蛋白饮食对慢性肾脏病进展的长期影响尚不清楚。我们在肾病饮食调整研究的长期随访期间评估了蛋白质限制对肾衰竭和全因死亡率的影响。方法 研究 A 是一项随机对照试验，从 1989 年到 1993 年，对 585 名主要患有非糖尿病肾病且肾小球滤过率中度下降（25 至 55 mL/min/1.73 m(2) [0.42 至 0.92 mL/s/1.73 m(2)]）的患者进行了一项随机对照试验，这些患者被分配为低蛋白饮食与普通饮食（0.58 与 1.3 g/kg/d）。我们使用登记来确定截至 2000 年 12 月 31 日肾衰竭（开始透析治疗或移植）或肾衰竭和全因死亡率的综合情况的发展情况。我们使用 Cox 回归模型和意向治疗原则来计算低蛋白饮食与常规蛋白质饮食的风险比，并根据基线肾小球滤过率和先前与肾小球滤过率下降率相关的其他因素进行调整。我们估计了整个随访期的风险比，然后在时间依赖性分析中分别估计了 2 个连续 6 年随访期的风险比。结果 肾衰竭和复合结局分别发生在 327 名 (56%) 和 380 名患者 (65%) 中。调整基线因素后，风险比分别为 0.89（95% 置信区间 [Cl]，0.71 至 1.12）和 0.88（95% CI，0.71 至 1.08）。前 6 年期间两种结果的调整后风险比（分别为 0.68；95% Cl，0.51 至 0.93 和 0.66；95% Cl，0.50 至 0.87）均低于之后（1.27；95% Cl，0.90 至 1.80 和 1.29；95% Cl，0.94 至 1.78；95% Cl，0.94 至 1.78）。交互作用 P 分别 = 0.008 和 0.002）。局限性包括缺乏试验结束后饮食摄入量和临床状况的数据。结论：2 至 3 年饮食蛋白质限制干预对非糖尿病肾病进展的疗效仍无定论。未来的研究应该包括更长持续时间的干预和随访。
Background The long-term effect of a low-protein diet on the progression of chronic kidney disease is unknown. We evaluated effects of protein restriction on kidney failure and all-cause mortality during extended follow-up of the Modification of Diet in Renal Disease Study. Methods Study A was a randomized controlled trial from 1989 to 1993 of 585 patients with predominantly nondiabetic kidney disease and a moderate decrease in glomerular filtration rate (25 to 55 mL/min/1.73 m(2) [0.42 to 0.92 mL/s/1.73 m(2)]) assigned to a low- versus usual-protein diet (0.58 versus 1.3 g/kg/d). We used registries to ascertain the development of kidney failure (initiation of dialysis therapy or transplantation) or a composite of kidney failure and all-cause mortality through December 31, 2000. We used Cox regression models and intention-to-treat principles to compute hazard ratios for the low- versus usual-protein diet, adjusted for baseline glomerular filtration rate and other factors previously associated with the rate of decrease in glomerular filtration rate. We estimated hazard ratios for the entire follow-up period and then, in time-dependent analyses, separately for 2 consecutive 6-year periods of follow-up. Results Kidney failure and the composite outcome occurred in 327 (56%) and 380 patients (65%), respectively. After adjustment for baseline factors, hazard ratios were 0.89 (95% confidence interval [Cl], 0.71 to 1.12) and 0.88 (95% Cl, 0.71 to 1.08), respectively. Adjusted hazard ratios for both outcomes were lower during the first 6 years (0.68; 95% Cl, 0.51 to 0.93 and 0.66; 95% Cl, 0.50 to 0.87, respectively) than afterward (1.27; 95% Cl, 0.90 to 1.80 and 1.29; 95% Cl, 0.94 to 1.78; interaction P = 0.008 and 0.002, respectively). Limitations include lack of data for dietary intake and clinical conditions after conclusion of the trial. Conclusion: The efficacy of a 2- to 3-year intervention of dietary protein restriction on progression of nondiabetic kidney disease remains inconclusive. Future studies should include a longer duration of intervention and follow-up.