Protein restriction for children with chronic renal failure

Protein restriction has been prescribed for some time for patients with chronic kidney disease (CKD). The effect of a low protein diet on delaying the progression to end-stage kidney disease (ESKD) in children and its impact on growth and nutrition remains unresolved.

To determine the efficacy of protein restricted diet in delaying the start of maintenance dialysis and maintaining nutrition in children.

Cochrane Renal group trials register, the Cochrane Central register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of nephrology textbooks, review articles and relevant trials.

Randomised control trials (RCTs) comparing un-restricted protein diet versus a protein restricted diet (to safe amounts recommended by WHO), with follow-up period of at least six months were included.

Two authors independently selected studies. Statistical analysis were performed using the random effects model. For dichotomous outcome results are expressed as relative risk (RR) with 95% confidence intervals (CI). Where continuous scales of measurement are used to assess the effects of treatment, the mean difference (WMD) was used.

Two studies (250 children) were identified, 124 received a protein restricted diet and 126 a control diet. No significant differences was found in the number of renal deaths (RR 1.12, 95% CI 0.54 to 2.33), progression of kidney disease (creatinine clearance at two years: WMD 1.47, 95% CI -1.19 to 4.14) or growth (weight - WMD -0.13, 95% CI -1.10 to 0.84; height - WMD -1.99, 95% CI -4.84 to 0.86).

Reducing protein intake does not appear to have significant impact in delaying the progression to ESKD in children.