CKD: Protein Restriction: Low Protein Diet (2018)
Author and Year:
D'Amico et al 1994
PubMed ID:
Article Title:
Effect of dietary protein restriction on the progression of renal failure: a prospective randomized trial.
Authors:
D'Amico G,Gentile M,Fellin G,Manna G,Cofano F
Journal:
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Year of publication:
1994
Volume:
9
Issue:
11
Page numbers:
1590-4
Study Design:
Randomized Controlled Trial
Risk of Bias Assessment Rating:
Positive
Inclusion Criteria:
1) were older than 18 years
2) had creatinine clearance between 70 and 15 ml/min that had remained stable or fell only moderately during the 3 months preceding the study
3) did not show evidence of potentially reversible diseases such as malignant hypertension, acute obstructions of infections of the urinary tract, drug-induced nephrotoxicity or acute flareups of an immunological mediated chronic glomerular disease
4) were not affected by systemic illnesses such as connectiv-tissue disorders, neoplastic diseases, or diabetes mellitus
5) did not present with a nephrotic syndrome
6) had not received during the last 6 months drugs that might alter the natural history of their rennal disease, such as immunosuprressive drugs or converting-zenzyme inhibitors
7) gave informed consent to participate in the trial and to accept the prescribed diets
Exclusion Criteria:
None reported
Research Purpose:
To investigate the effects on the rte of decline of renal function of two diets, a controlled protein diet and 1 g protein/kg/ideal body weight/d and a low protein diet of 0.6g/kg ibw/d.
Blinding efforts:
None reported.
Study Location:
Italy
Source(s) of Funding:
Government
Please specify names of funders:
National Research Council
Quality Criteria Checklist: Primary Research
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Relevance Questions | |||
1. | Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) | Yes | |
2. | Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? | Yes | |
3. | Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? | Yes | |
4. | Is the intervention or procedure feasible? (NA for some epidemiological studies) | Yes | |
Validity Questions | |||
1. | Was the research question clearly stated? | Yes | |
1.1. | Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? | Yes | |
1.2. | Was (were) the outcome(s) [dependent variable(s)] clearly indicated? | Yes | |
1.3. | Were the target population and setting specified? | Yes | |
2. | Was the selection of study subjects/patients free from bias? | Yes | |
2.1. | Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? | Yes | |
2.2. | Were criteria applied equally to all study groups? | Yes | |
2.3. | Were health, demographics, and other characteristics of subjects described? | Yes | |
2.4. | Were the subjects/patients a representative sample of the relevant population? | Yes | |
3. | Were study groups comparable? | Yes | |
3.1. | Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) | Yes | |
3.2. | Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? | Yes | |
3.3. | Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) | Yes | |
4. | Was method of handling withdrawals described? | ??? | |
4.1. | Were follow-up methods described and the same for all groups? | ??? | |
4.2. | Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) | ??? | |
4.3. | Were all enrolled subjects/patients (in the original sample) accounted for? | ??? | |
4.4. | Were reasons for withdrawals similar across groups? | ??? | |
5. | Was blinding used to prevent introduction of bias? | ??? | |
5.1. | In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? | ??? | |
5.2. | Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) | ??? | |
6. | Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? | ??? | |
6.1. | In RCT or other intervention trial, were protocols described for all regimens studied? | ??? | |
6.3. | Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? | ??? | |
6.4. | Was the amount of exposure and, if relevant, subject/patient compliance measured? | ??? | |
6.5. | Were co-interventions (e.g., ancillary treatments, other therapies) described? | ??? | |
6.6. | Were extra or unplanned treatments described? | ??? | |
6.7. | Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? | ??? | |
7. | Were outcomes clearly defined and the measurements valid and reliable? | ??? | |
7.1. | Were primary and secondary endpoints described and relevant to the question? | ??? | |
7.2. | Were nutrition measures appropriate to question and outcomes of concern? | ??? | |
7.3. | Was the period of follow-up long enough for important outcome(s) to occur? | ??? | |
7.4. | Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? | ??? | |
7.5. | Was the measurement of effect at an appropriate level of precision? | ??? | |
7.6. | Were other factors accounted for (measured) that could affect outcomes? | ??? | |
7.7. | Were the measurements conducted consistently across groups? | ??? | |
8. | Was the statistical analysis appropriate for the study design and type of outcome indicators? | ??? | |
8.1. | Were statistical analyses adequately described and the results reported appropriately? | ??? | |
8.2. | Were correct statistical tests used and assumptions of test not violated? | ??? | |
8.3. | Were statistics reported with levels of significance and/or confidence intervals? | ??? | |
8.4. | Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? | ??? | |
8.5. | Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? | ??? | |
8.6. | Was clinical significance as well as statistical significance reported? | ??? | |
8.7. | If negative findings, was a power calculation reported to address type 2 error? | ??? | |
9. | Are conclusions supported by results with biases and limitations taken into consideration? | ??? | |
9.1. | Is there a discussion of findings? | ??? | |
9.2. | Are biases and study limitations identified and discussed? | ??? | |
10. | Is bias due to study's funding or sponsorship unlikely? | ??? | |
10.1. | Were sources of funding and investigators' affiliations described? | ??? | |
10.2. | Was the study free from apparent conflict of interest? | ??? | |