Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy
Effect of dietary protein restriction on prognosis in patients with diabetic nephropathy
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DOI：
10.1046/j.1523-1755.2002.00421.x
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发表时间：
2002-07-01
影响因子：
19.6
通讯作者：
Parving, HH
中科院分区：
文献类型：
--
作者：
Hansen, HP;Tauber-Lassen, E;Parving, HH
背景。最近的数据表明，饮食蛋白质限制可以提高非糖尿病肾病的生存率并延缓终末期肾病 (ESRD) 的进展。我们研究的目的是确定饮食蛋白质限制对糖尿病肾病患者生存和进展为 ESRD 的影响。方法。进行了一项为期四年的前瞻性、隐蔽随机对照试验，比较低蛋白饮食（0.6 g/kg/天）与普通蛋白饮食的效果。该研究包括 82 名患有进行性糖尿病肾病的 1 型糖尿病患者[研究前肾小球滤过率 (GFR) 平均下降 7.1 mL/min/年（95% CI，5.8 至 8.5）]。主要结果指标是 GFR 下降以及 ESRD 或死亡的发展。结果。在随访期间，常规蛋白质饮食组每天摄入 1.02 克/公斤（95% CI；0.95 至 1.10），而低蛋白质饮食组每天摄入 0.89 克/公斤（0.83 至 0.95）（P = 0.005）。常规蛋白质饮食组的 GFR 平均下降为 3.9 mL/min/年（2.7 至 5.2），低蛋白饮食组的平均下降为 3.8（2.8 至 4.8）。接受普通蛋白质饮食的患者中有 27% 发生终末期肾病或死亡，而接受低蛋白饮食的患者这一比例为 10%（对数秩检验；P = 0.042）。根据心血管疾病的基线情况进行调整后，接受低蛋白饮食的患者的 ESRD 或死亡相对风险为 0.23（0.07 至 0.72）（P = 0.01）。随访期间两个饮食组的血压和血糖控制相当。结论。适度的饮食蛋白质限制除了可以带来抗高血压治疗的有益效果外，还可以改善患有进行性糖尿病肾病的 1 型糖尿病患者的预后。
Background. Recent data suggest that dietary protein restriction improves survival and delays the progression to end-stage renal disease (ESRD) in non-diabetic nephropathies. The purpose of our study was to determine the effect of dietary protein restriction on survival and progression to ESRD in diabetic nephropathy.Methods. A four-year prospective, controlled trial with concealed randomization was performed comparing the effects of a low-protein diet (0.6 g kg/day) with a usual-protein diet. The study included 82 type 1 diabetic patients with progressive diabetic nephropathy [pre-study mean decline in glomerular filtration rate (GFR) 7.1 mL/min/year (95% CI, 5.8 to 8.5)]. The main outcome measures were decline in GFR and development of ESRD or death.Results. During the follow-up period the usual-protein diet group consumed 1.02 g/kg/day (95% CI; 0.95 to 1.10) as compared with 0.89 (0.83 to 0.95) in the low-protein diet group (P = 0.005). The mean declines in GFR were 3.9 mL/min/year (2.7 to 5.2) in the usual-protein diet group and 3.8 (2.8 to 4.8) in the low-protein diet group. ESRD or death occurred in 27% of patients on a usual-protein diet as compared with 10% on a low-protein diet (log-rank test; P = 0.042). The relative risk of ESRD or death was 0.23 (0.07 to 0.72) for patients assigned to a low-protein diet, after an adjustment at baseline for the presence of cardiovascular disease (P = 0.01). Blood pressure and glycemic control were comparable in the two diet groups during the follow-up period.Conclusion. Moderate dietary protein restriction improves prognosis in type 1 diabetic patients with progressive diabetic nephropathy in addition to the beneficial effect of antihypertensive treatment.