{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:16:10Z","timestamp":1790709370488,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2018,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Recent data pose the question whether conservative management of chronic kidney disease (CKD) by means of a low\u2010protein diet can be a safe and effective means to avoid or defer transition to dialysis therapy without causing protein\u2010energy wasting or cachexia. We aimed to systematically review and meta\u2010analyse the controlled clinical trials with adequate participants in each trial, providing rigorous contemporary evidence of the impact of a low\u2010protein diet in the management of uraemia and its complications in patients with CKD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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\u2010analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 16 controlled trials of low\u2010protein diet in CKD that met the stringent qualification criteria including having 30 or more participants. Compared with diets with protein intake of &gt;0.8\u00a0g\/kg\/day, diets with restricted protein intake (&lt;0.8\u00a0g\/kg\/day) were associated with higher serum bicarbonate levels, lower phosphorus levels, lower azotemia, lower rates of progression to end\u2010stage renal disease, and a trend towards lower rates of all\u2010cause death. In addition, very\u2010low\u2010protein diets (protein intake &lt;0.4\u00a0g\/kg\/day) were associated with greater preservation of kidney function and reduction in the rate of progression to end\u2010stage renal disease. Safety and adherence to a low\u2010protein diet was not inferior to a normal protein diet, and there was no difference in the rate of malnutrition or protein\u2010energy wasting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this pooled analysis of moderate\u2010size controlled trials, a low\u2010protein diet appears to enhance the conservative management of non\u2010dialysis\u2010dependent 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\u2010energy wasting and cachexia remains minimal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.12264","type":"journal-article","created":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T07:10:02Z","timestamp":1509606602000},"page":"235-245","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":211,"title":["Low\u2010protein diet for conservative management of chronic kidney disease: a systematic review and meta\u2010analysis of controlled trials"],"prefix":"10.1002","volume":"9","author":[{"given":"Connie M.","family":"Rhee","sequence":"first","affiliation":[{"name":"Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension University of California Irvine Medical Center  Orange CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyed\u2010Foad","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension University of California Irvine Medical Center  Orange CA USA"},{"name":"Department of Medicine University of California Irvine Health  Orange CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Csaba P.","family":"Kovesdy","sequence":"additional","affiliation":[{"name":"Division of Nephrology University of Tennessee Health Science Center  Memphis TN USA"},{"name":"Memphis Veterans Affairs Medical Center  Memphis TN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamyar","family":"Kalantar\u2010Zadeh","sequence":"additional","affiliation":[{"name":"Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension University of California Irvine Medical Center  Orange CA USA"},{"name":"Department of Medicine University of California Irvine Health  Orange CA USA"},{"name":"Tibor Rubin Veterans Affairs Long Beach Healthcare System  Long Beach CA USA"},{"name":"Department of Epidemiology UCLA Fielding School of Public Health  Los Angeles CA USA"},{"name":"Los Angeles Biomedical Research Institute at Harbor\u2010UCLA  Torrance CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60115-9"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2012.66"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1000552"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904655"},{"key":"e_1_2_7_6_1","doi-asserted-by":"crossref","first-page":"115","DOI":"10.23736\/S0031-0808.17.03298-0","article-title":"Conservative management of chronic kidney disease: how to avoid or defer dialysis","volume":"59","author":"Bolasco P","year":"2017","journal-title":"Panminerva Med"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11255-016-1224-0"},{"key":"e_1_2_7_8_1","doi-asserted-by":"crossref","first-page":"157","DOI":"10.23736\/S0031-0808.16.03264-X","article-title":"The role of low protein diet in ameliorating proteinuria and deferring dialysis initiation: what is old and what is new","volume":"59","author":"Wang M","year":"2017","journal-title":"Panminerva Med"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000000342"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-016-0304-9"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199403313301301"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/ajkd.1998.v31.pm9631839"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001892.pub3"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.3945\/ajcn.112.036418"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0000000000000171"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-13-104"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1700312"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfp085"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/542704"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfm576"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(91)92977-A"},{"key":"e_1_2_7_22_1","first-page":"837","article-title":"Failure of dietary protein and phosphate restriction to retard the rate of progression of chronic renal failure: a prospective, randomized, controlled trial","volume":"81","author":"Williams PS","year":"1991","journal-title":"Q J Med"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198912283212601"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(84)90818-3"},{"key":"e_1_2_7_25_1","first-page":"S96","article-title":"Protein\u2010restricted diets in chronic renal failure: a four year follow\u2010up shows limited indications","volume":"27","author":"Rosman JB","year":"1989","journal-title":"Kidney Int Suppl"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2015040369"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2006.12.012"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.jrn.2004.01.008"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.1999.10718887"},{"key":"e_1_2_7_30_1","first-page":"580","article-title":"Treatment with low\u2010protein diet and caloric supplements in patients with chronic kidney failure in predialysis. Comparative study","volume":"198","author":"Montes\u2010Delgado R","year":"1998","journal-title":"Rev Clin Esp"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1159\/000185940"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2007.02.278"},{"key":"e_1_2_7_33_1","first-page":"47","article-title":"Effects of low\u2010protein diet supplemented with ketoacids and erythropoietin in chronic renal failure: a long\u2010term metabolic study","volume":"6","author":"Teplan V","year":"2001","journal-title":"Ann Transplant"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12134"},{"key":"e_1_2_7_35_1","first-page":"608","article-title":"Acute and persistent antiproteinuric effect of a low\u2010protein diet in chronic kidney disease","volume":"26","author":"Di Iorio BR","year":"2009","journal-title":"G Ital Nefrol"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.304.6821.216"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-124-7-199604010-00002"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0097656"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfw247"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfn633"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcsm.12089"}],"container-title":["Journal of Cachexia, Sarcopenia and Muscle"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjcsm.12264","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jcsm.12264","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,24]],"date-time":"2023-09-24T08:35:51Z","timestamp":1695544551000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jcsm.12264"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11,2]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2018,4]]}},"alternative-id":["10.1002\/jcsm.12264"],"URL":"https:\/\/doi.org\/10.1002\/jcsm.12264","archive":["Portico"],"relation":{},"ISSN":["2190-5991","2190-6009"],"issn-type":[{"value":"2190-5991","type":"print"},{"value":"2190-6009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,2]]},"assertion":[{"value":"2016-08-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-10-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}