Protein modified diets of all types lasting a minimum of 4 months were considered
with protein intake ranging from 0.3 to 0.8 g/kg per day. Overall protein restriction appeared to slow progression of CKD, but not by much on average. Individual variability suggests some may benefit more than others. Results of meta analysis imply that patients can delay dialysis by, on average around one or 2 months. Positive Selleckchem GDC973 but non-significant correlation between improvement in GFR and level of protein restriction is evident. There were insufficient studies to recommend a level of protein intake. Furthermore, problems of non-compliance remain a significant issue. The review also considered different sources of protein (e.g. red meat, chicken, fish, vegetarian); however, relevant studies are of short duration only. The authors consider that the available information supports further research in this area. The number of studies that include people with type 2 diabetes are limited. The study by Dussol et al.121 was the only other RCT identified that was not reviewed by Robertson et al.120 This 2 year single centre RCT of type 1 and type
2 diabetes indicated that the low-protein diet did not alter the course of GFR or of AER in people with diabetes with incipient or overt nephropathy. Table A6 includes a summary of studies identified by the search strategy. The studies are characterized
by being small and of short duration. Relevant details are provided NVP-LDE225 chemical structure below; however, as for dietary fat, there are insufficient reliable studies that provide evidence to support a recommendation in relation protein restriction in the prevention and management Astemizole of CKD in people with type 2 diabetes. When considering the evidence related to salt intake and CKD in people with type 2 diabetes, the following points made based on a literature review for preparation of a Cochrane Protocol are noteworthy:122 Dietary salt is important in BP control in both hypertensives and normotensives (supported by meta-analyses) and therefore expect that this could be protective in the development and progression of CKD. Table A7 presents a summary of studies identified by the search strategy in relation to the assessment of the role of restricted salt intake. As for protein restriction the studies are small and of short duration. Details of the studies are included in Table A7; however, it is concluded that there are insufficient reliable studies that provide evidence to support a recommendation in relation to restriction of dietary salt and the prevention and management of CKD in people with type 2 diabetes. Smoking increases the risk of the development and progression of CKD in people with type 2 diabetes (Evidence Level II – Aetiology).