Nutrition in Chronic Kidney Disease Stages 3 to 5: Balancing Protein Restriction Against Protein-Energy Wasting
DOI:
https://doi.org/10.5281/zenodo.22281697Keywords:
Chronic kidney disease, Protein restriction, Protein-energy wasting, Evidence quality, GuidelinesAbstract
Dietary protein restriction has been offered in chronic kidney disease for decades to postpone dialysis, while protein-energy
wasting is among the strongest predictors of death in the same patients. The randomised evidence resolves less of that tension than
the guidance implies. A Cochrane review of 17 studies in 2,996 participants found that a very low protein intake probably reduces
the number reaching kidney failure against a low intake, at a risk ratio of 0.65 (95% CI 0.49 to 0.85), while making little or no
difference to death at 1.26 (0.62 to 2.54). Comparing a low intake with a normal one, neither death at 0.77 (0.51 to 1.18) nor
kidney failure at 1.05 (0.73 to 1.53) moved. The complication is on the harm side. Final body weight was reported in three of the
17 studies, in 89 participants, with an interval spanning six kilograms in each direction. Twelve studies reported no wasting at all
and three reported small numbers. Quality of life was not formally assessed in any study. Wasting affects 11 to 54 per cent of
patients at these stages and carries a hazard ratio for death of 1.40 (1.04 to 1.89), yet the trials recruited metabolically stable
patients. The trade-off in the title is therefore between a measured benefit and an unmeasured harm, in a population the trials
largely excluded.
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