Evidence map›Paper›PMID 29094800›Full record

SynthesisJournal of cachexia, sarcopenia and muscle2018

Low-protein diet for conservative management of chronic kidney disease: a systematic review and meta-analysis of controlled trials.

Connie M Rhee, Seyed-Foad Ahmadi, Csaba P Kovesdy, Kamyar Kalantar-Zadeh

Registry-linked trialOpen access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Journal of cachexia, sarcopenia and muscle, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05015647 (Is There Any Indication for Protein Free Products in Patients With Advanced CKD at Risk of Malnutrition?A Pilot Randomized Controlled Trial), which is not on this map. Cited by 121 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
121citing papers in PubMed, 9 pooled it
9.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05015647 nacompletednot on this map

Is There Any Indication for Protein Free Products in Patients With Advanced CKD at Risk of Malnutrition?A Pilot Randomized Controlled Trial

TypeinterventionalSponsorFondazione IRCCS Ca' Granda, Ospedale Maggiore PoliclinicoRan2018 to 2020Enrolled35ConditionsChronic Kidney Diseases, MalnutritionArmsLP group, NP group
3 · Its place in the literature

Who cites it

121 citing papers in PubMed, 9 syntheses or guidelines pooled it, 226 citations in OpenAlex.

  1. Effects of dietary interventions for metabolic acidosis in chronic kidney disease: a systematic review and meta-analysis.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025
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61 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 4 institutions in 1 country.

Connie M RheeHarold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
Seyed-Foad AhmadiHarold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
Csaba P KovesdyDivision of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
Kamyar Kalantar-ZadehHarold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.
Memphis VA Medical Center · USUCLA Health · USUniversity of California, Irvine · USUniversity of California, Irvine Medical Center · US

Funding

MALNUTRITION, DIET AND RACIAL DISPARITIES IN CKDK24DK091419 · NIDDK · UNIVERSITY OF CALIFORNIA-IRVINE · PI KALANTAR-ZADEH, KAMYAR · 2011 to 2020
$1.8M
Hypothyroidism, Cardiovascular Health, and Survival in Kidney DiseaseK23DK102903 · NIDDK · UNIVERSITY OF CALIFORNIA-IRVINE · PI RHEE, CONNIE MEEYOUNG · 2014 to 2018
$955k
Racial and Cardiovascular Risk Factor Anomalies in CKDR01DK096920 · NIDDK · UNIVERSITY OF TENNESSEE HEALTH SCI CTR · PI KALANTAR-ZADEH, KAMYAR, KOVESDY, CSABA PAL · 2013 to 2015
$909k
NIDDK NIH HHS K23 DK102903NIDDK NIH HHS K24 DK091419NIDDK NIH HHS R01 DK096920
6 · The paper itself

Abstract

backgroundRecent data pose the question whether conservative management of chronic kidney disease (CKD) by means of a low-protein diet can be a safe and effective means to avoid or defer transition to dialysis therapy without causing protein-energy wasting or cachexia. We aimed to systematically review and meta-analyse the controlled clinical trials with adequate participants in each trial, providing rigorous contemporary evidence of the impact of a low-protein diet in the management of uraemia and its complications in patients with CKD.

methodsWe searched MEDLINE (PubMed) and other sources for controlled trials on CKD to compare clinical management of CKD patients under various levels of dietary protein intake or to compare restricted protein intake with other interventions. Studies with similar patients, interventions, and outcomes were included in the meta-analyses.

resultsWe identified 16 controlled trials of low-protein diet in CKD that met the stringent qualification criteria including having 30 or more participants. Compared with diets with protein intake of >0.8 g/kg/day, diets with restricted protein intake (<0.8 g/kg/day) were associated with higher serum bicarbonate levels, lower phosphorus levels, lower azotemia, lower rates of progression to end-stage renal disease, and a trend towards lower rates of all-cause death. In addition, very-low-protein diets (protein intake <0.4 g/kg/day) were associated with greater preservation of kidney function and reduction in the rate of progression to end-stage renal disease. Safety and adherence to a low-protein diet was not inferior to a normal protein diet, and there was no difference in the rate of malnutrition or protein-energy wasting.

conclusionsIn this pooled analysis of moderate-size controlled trials, a low-protein diet appears to enhance the conservative management of non-dialysis-dependent CKD and may be considered as a potential option for CKD patients who wish to avoid or defer dialysis initiation and to slow down the progression of CKD, while the risk of protein-energy wasting and cachexia remains minimal.

Indexed as

Diet, Protein-RestrictedDisease ProgressionHumansRandomized Controlled Trials as TopicRenal Insufficiency, ChronicAll-cause deathCachexiaChronic kidney diseaseConservative managementEnd-stage renal diseaseGlomerular filtration rateLow-protein dietProtein-energy wasting

Identifiers

PMID29094800
PMCPMC5879959
OpenAlexW2766047719

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.