Pembatasan protein untuk penyakit buah pinggang diabetes
Abstract
Background
Diabetic renal disease (diabetic nephropathy) is a leading cause of end‐stage renal failure. Once the process has started, it cannot be reversed by glycaemic control, but progression might be slowed by control of blood pressure and protein restriction.
Objectives
To assess the effects of dietary protein restriction on the progression of diabetic nephropathy in patients with diabetes.
Search methods
We searched The Cochrane Library, MEDLINE, EMBASE, ISI Proceedings, Science Citation Index Expanded and bibliographies of included studies.
Selection criteria
Randomised controlled trials (RCTs) and before and after studies of the effects of a modified or restricted protein diet on diabetic renal function in people with type 1 or type 2 diabetes following diet for at least four months were considered.
Data collection and analysis
Two reviewers performed data extraction and evaluation of quality independently. Pooling of results was done by means of random‐effects model.
Main results
Twelve studies were included, nine RCTs and three before and after studies. Only one study explored all‐cause mortality and end‐stage renal disease (ESRD) as endpoints. The relative risk (RR) of ESRD or death was 0.23 (95% confidence interval (CI) 0.07 to 0.72) for patients assigned to a low protein diet (LPD). Pooling of the seven RCTs in patients with type 1 diabetes resulted in a non‐significant reduction in the decline of glomerular filtration rate (GFR) of 0.1 ml/min/month (95% CI ‐0.1 to 0.3) in the LPD group. For type 2 diabetes, one trial showed a small insignificant improvement in the rate of decline of GFR in the protein‐restricted group and a second found a similar decline in both the intervention and control groups. Actual protein intake in the intervention groups ranged from 0.7 to 1.1 g/kg/day. One study noted malnutrition in the LPD group. We found no data on the effects of LPDs on health‐related quality of life and costs.
Authors' conclusions
The results show that reducing protein intake appears to slightly slow progression to renal failure but not statistically significantly so. However, questions concerning the level of protein intake and compliance remain. Further longer‐term research on large representative groups of patients with both type 1 and type 2 diabetes mellitus is necessary. Because of the variability amongst patients, there might perhaps be a six month therapeutic trial of protein restriction in all individuals, with continuation only in those who responded best. Trials are required of different types of protein.
PICO
Plain language summary
Pembatasan protein untuk penyakit buah pinggang diabetes
Berdasarkan 12 kajian, termasuk dari lapan hingga 160 orang dengan diabetes jenis 1 dan jenis 2 untuk tempoh purata sekurang‐kurangnya empat bulan, pembatasan pengambilan protein melambatkan progressi penyakit buah pinggang diabetes, tetapi tidaklah banyak secara purata. Namun, perbezaan individu wujud, oleh itu diet rendah‐protein boleh memberi manfaat kepada sesetengah individu. Diet rendah‐protein boleh menjadi sukar untuk dipatuhi, terutamanya dalam jangka masa panjang. Mengurangkan amaun protein haiwan adalah kaedah lazim tetapi beberapa bukti mencadangkan bahawa satu anjakan daripada daging merah ke daging putih dan ikan atau sayur‐sayuran mungkin memberi keputusan yang serupa. Kami mendapati tiada data mengenai kesan diet rendah‐protein ke atas kesihatan yang berkaitan dengan kualiti hidup dan kos.
