Effect of Restricting Dietary Protein on the Progression of Renal Failure in Patients with Insulin-Dependent Diabetes Mellitus K. ZELLER, E. WHITTAKER, L. SULLIVAN, P. RASKIN, H.R. JACOBSON N Engl J Med 324:78-84, 1991

This report compares the progression of renal failure in type-I diabetic patients fed either a low or a normal protein diet. In a prospective, randomized, controlled fashion, 47 adult patients were placed either on a 0.6 g/ kg daily protein intake (study) or a greater than 1.0 g/ kg (control) daily protein intake. Dietary phosphorus was maintained between 0.5 and 1.0 g for study patients and greater than 1.0 g for control patients. Renal function was monitored by iothalamate and creatinine clearance measurements at 3- to 6-month intervals. Patients were studied for periods up to 46 months (mean 34.7 months). Study patients had a slower deterioration of renal function with clearance decreasing at 25 to 40% the rate observed in control patients. Proteinuria was reduced by 45% in the study group when compared to the control group (2.9 g/dL vs 5.4 g/dL). The authors conclude that a protein-phosphorus-restricted diet can slow progression of renal failure in diabetic patients.