Review: Effects of Dietary Protein and Phosphorus Restriction on the Progression of Chronic Renal Failure

Zeller, Kathleen R.

doi:10.1097/00000441-198711000-00007

Cited by 9 publications

(2 citation statements)

References 50 publications

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“…Several metabolic factors have been proposed to contribute to the progression of hypertensive nephrosclerosis including gout, 22 diabetes mellitus, 22 dyslipoproteinemia, 23 low dietary potassium 24 or linoleic acid, 25 and high dietary protein 26 or phosphate. 27 First, there were no systematic dietary changes during the study.…”

Section: Figure 2 P/o/ Of Changes In Quantity Of Antihypertensive Drmentioning

confidence: 99%

Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis.

et al. 1989

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Seventy-nine hypertensive nephrosclerosis patients i entered a prospective randomized singleblind study to 1) establish the pattern of decay of renal function in this population and the variability therein and 2) to determine if strict diastolic blood pressure (DBP) control (<80 mm Hg) is more effective than conventional levels (90-95 mm Hg) in conserving renal function. Because of unexpected significant improvement in renal function in patients from both groups, which changed the perspectives on the course of this disease as described herein, this report is being published before completion of the trial. The selection criteria were 1) serum creatinine concentration of 1.6-7.0 mg/dl, 2) glomerular filtration rate of less than 70 ml/min/1.73 m 2 , and 3) absence of diseases (other than hypertension) known to destroy renal function. Renal function was assessed by glomerular filtration rate ([ l2S I]iothalamate clearance) and serum creatinine concentration. Before randomization, DBP was aggressively treated to reduce it to less than 80 mm Hg. Twenty-two subjects (14 in the strict DBP control group and eight in the conventional DBP control group) have been enrolled in the study for 36 months. In contrast to results from previous studies in humans and rats, renal function improved in both patient groups. Thus, irrevocable progression of renal damage after onset of renal failure from high blood pressure does not necessarily occur, and in fact, long-term improvement of renal function resulted from the effects of the study itself. The study design involving the 2-4-month initial period of aggressive DBP control at 80 mm Hg or less followed by control of DBP at less than 90 mm Hg was associated with long-term improvement in renal function. (Hypertension 1989; 13:766-772)

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Section: Figure 2 P/o/ Of Changes In Quantity Of Antihypertensive Drmentioning

confidence: 99%

Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis.

et al. 1989

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“…The most common form of dietary phosphate restriction is the use of protein-re duced diets. Their beneficial effects in reducing serum urea concentrations and ameliorating uremic symptoms are well documented [6], Reduction of protein and phosphate intake has also been claimed to result in a reduced rate of progrès- sion of renal failure [6,7], The effect of treatment with protein-and phosphate-and protein-restricted diet on se rum phosphate levels is well known. In contrast, there are only limited data on the effects of phosphate-protein re striction on the concentrations of vitamin D metabolites in renal insufficiency [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Increase of Calcitriol during Treatment with Protein-Reduced Diet in Patients with Renal Failure

Wilske

Attman

1994

Nephron

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Vitamin D metabolites 25-OH-D₃ (calcifediol) and 1,25-(OH)₂-D₃ (calcitriol) were measured in plasma in 16 patients with advanced chronic renal failure during treatment with a protein-restricted diet for 6 months. The glomerular filtration rate (GFR) decreased only marginally, from 8.3 to 7.9 ml/min, during the study while there was a significant decrease of serum urea levels after the initiation of the protein-reduced diet. Calcitriol levels rose significantly (p < 0.05) after 3 months from 17.1 to 27.7 pg/ml but fell after another 3 months to nearly their initial values, 15.3 pg/ml. The serum phosphate levels changed during the same periods from 1.99 to 1.67 to 1.93 mmol/l. There were significant inverse correlations between the calcitriol and phosphate levels at the start and after 3 months but not after 6 months. There was also a significant correlation between the changes in calcitriol and initial GFR. A subgroup of patients with decreased or unchanged calcitriol concentrations during dietary treatment had significantly higher serum phosphate and creatinine and significantly lower standard bicarbonate concentrations. Multivariate regression analysis for the pooled set of data with calcitriol as the dependent variable showed significant values for GFR (p < 0.02), body mass index (p < 0.02), and serum phosphate concentrations (p < 0.04). These results show the importance of phosphate control and renal function for the regulation of calcitriol synthesis.

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The Uremic Syndrome

Brennan

Eknoyan

1989

Contemporary Nephrology

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Review: Effects of Dietary Protein and Phosphorus Restriction on the Progression of Chronic Renal Failure

Cited by 9 publications

References 50 publications

Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis.

Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis.

Increase of Calcitriol during Treatment with Protein-Reduced Diet in Patients with Renal Failure

The Uremic Syndrome

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