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.

Read the full abstract...

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.


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).