Protein restriction for children with chronic kidney disease

Low protein diet can delay kidney failure in adults with kidney disease, however a diet low in protein in children raises concern of poor growth. The review identified 2 studies (250 children) in children with kidney disease and found that a low protein diet does not delay progression to kidney failure (end-stage kidney disease). There remains some concern regarding adverse effect on growth.

Authors' conclusions: 

Reducing protein intake does not appear to have significant impact in delaying the progression to ESKD in children.

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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 studies.

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 risk ratio (RR) with 95% confidence intervals (CI). Where continuous scales of measurement are used to assess the effects of treatment, the mean difference (MD) 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: MD 1.47, 95% CI -1.19 to 4.14) or growth (weight - MD -0.13, 95% CI -1.10 to 0.84; height - MD -1.99, 95% CI -4.84 to 0.86).

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