• Harris D, Thomas M, Johnson D, Nicholls K, Gillin A. Prevention of progression of kidney disease. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2006 Apr. 16 p. [46 references]

This is the current release of the guideline.

• Chronic kidney disease (CKD)
• Renal failure

Assessment of Therapeutic Effectiveness
Management
Prevention
Treatment

Family Practice
Internal Medicine
Nephrology
Nutrition
Pediatrics

Dietitians
Physicians

To evaluate the available clinical evidence pertaining to the effect of protein-restricted diets on the progression of chronic kidney disease (CKD)

Adults and children with chronic kidney disease (CKD)

Dietary protein restriction

• Glomerular filtration rate (GFR)
• Progression of chronic kidney disease
• Effect of restricted protein diets on nutrition

Searches of Electronic Databases

Databases Searched: Medline (1999 to November Week 2, 2003). Medical Subject Heading (MeSH) terms for kidney diseases were combined with MeSH terms and text words for dietary protein restriction. The results were then combined with the Cochrane highly sensitive search strategy for randomised controlled trials and MeSH terms and text words for identifying meta-analyses and systematic reviews. The Cochrane Renal Group Specialised Register of Randomised Controlled Trials was also searched for relevant trials not indexed by Medline.

Date Searched: 16 December 2003

Not stated

Weighting According to a Rating Scheme (Scheme Given)

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

Review of Published Meta-Analyses
Systematic Review with Evidence Tables

Not stated

Expert Consensus

Not stated

A formal cost analysis was not performed and published cost analyses were not reviewed.

Comparison with Guidelines from Other Groups
Peer Review

Recommendations of Others. Recommendations regarding dietary protein restriction for prevention of progression of kidney disease from the following groups were discussed: Kidney Disease Outcomes Quality Initiative, British Dietetic Association Renal Nutrition Group, European Dialysis and Transplant Nurses Association – European Renal Care Association, and European Society of Parenteral and Enteral Nutrition.

Definitions for the levels of evidence (I–IV) can be found at the end of the "Major Recommendations" field.

1. A protein-controlled diet consisting of 0.75 to 1.0 g/kg/day, is recommended for adults with chronic renal disease (CKD). The administration of a low protein diet (<0.6 g/kg/day) to slow renal failure progression is not justified when the reported clinically modest benefit on glomerular filtration rate (GFR) decline is weighed against the concomitant significant declines in clinical and biochemical parameters of nutrition. (Level I evidence)
2. For children, reduction of dietary protein intake to the lowest safe amounts recommended by the World Health Organisation (0.8 to 1.1 g/kg/day depending on age) has not been shown in a small randomised controlled trial (RCT) to decrease the progression of CKD and is therefore not currently recommended. (Level II evidence)

Definitions:

Levels of Evidence

Level I: Evidence obtained from a systematic review of all relevant randomized controlled trials (RCTs)

Level II: Evidence obtained from at least one properly designed RCT

Level III: Evidence obtained from well-designed pseudo-randomized controlled trials (alternate allocation or some other method); comparative studies with concurrent controls and allocation not randomized, cohort studies, case-control studies, interrupted time series with a control group; comparative studies with historical control, two or more single arm studies, interrupted time series without a parallel control group

Level IV: Evidence obtained from case series, either post-test or pretest/post-test

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

Appropriate use of dietary protein restriction for the prevention of progression of chronic kidney disease

Low or restricted protein diets may have an adverse effect on clinical and biochemical parameters of nutrition.

An implementation strategy was not provided.

Living with Illness

Effectiveness

• Harris D, Thomas M, Johnson D, Nicholls K, Gillin A. Prevention of progression of kidney disease. Westmead NSW (Australia): CARI - Caring for Australasians with Renal Impairment; 2006 Apr. 16 p. [46 references]

Not applicable: The guideline was not adapted from another source.

2006 Apr

Caring for Australasians with Renal Impairment - Disease Specific Society

Not stated

Not stated

David Harris, Convenor (Westmead, New South Wales); Merlin Thomas (Prahran, Victoria); David Johnson (Woolloongabba, Queensland); Kathy Nicholls (Parkville, Victoria); Adrian Gillin (Camperdown, New South Wales)

All guideline writers are required to fill out a declaration of conflict of interest.

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on July 27, 2007.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.