Limited-protein diet: a means of delaying the progression of chronic renal disease?

Recent studies suggest that restricting the dietary protein intake of patients with progressive renal disease slows their loss of renal function. Studies in animals have shown that an increase in the filtration rates of individual nephrons (hyperfiltration), an adaptive response to loss of renal mass, appears to induce progressive renal damage and that such damage may be prevented by dietary protein restriction. Preliminary evidence suggests that restriction of protein intake to less than 50 g/d in man has a similar beneficial effect in slowing the progression of chronic renal disease. Dietary therapy appears to be particularly effective for patients with early renal disease, allowing a doubling in the time until dialysis is required in many cases. Although large-scale clinical studies are planned, there is now sufficient evidence to warrant the use of moderate protein restriction (to less than 50 g/d) in most patients suffering from progressive renal disease. Such therapy should only be instituted with expert dietary and nephrologic consultation.