Abstract
This report describes growth and nutrition data from the feasibility phase of a clinical trial that was designed to evaluate the effect of diet protein modification in infants with chronic renal insufficiency (CRI). The purpose of the proposed trial was to compare the safety (effect on growth in length) and efficacy [effect on glomerular filtration rate (GFR)] of a diet with a low protein:energy (P∶E) ratio versus a control diet in such patients. Twenty-four infants with GFRs less than 55 ml/min per 1.73 m2 were randomly assigned at 8 months of age to receive either a low-protein (P∶E ratio 5.6%) or control protein (P∶E ratio 10.4%) formula, which resulted in average protein intakes of 1.4 and 2.4 g/kg per day in the low and control groups, respectively. Overall energy intakes over a 10-month period of study averaged 92%±12% recommended dietary allowance (RDA) for length in the low-protein group and 92±15% RDA in the control group. Weight for age standard deviation scores (SDS) were comparably low in both groups at the time of randomization (low-protein —2.0±1.3, control −1.9±1.1) and at the end of the study (low −1.9±1.2, control −1.7±0.9). Length for age SDS at entry tended to be lower in the low-protein group but were not significantly different in the two groups (low −2.2±1.4 vs. control −1.7±1.4). However, at 18 months the low-protein group had a significantly lower SDS for length (−2.6±1.2 vs. −1.7±1.4). The length velocity SDS from 12 to 18 months were also different, with the low-protein group remaining strongly negative (−1.0±0.9) while the control group improved (−0.1±1.1). We conclude from this feasibility study that there is a need for caution in advising the use of low-protein intake in infants with CRI. However, our findings should be regarded as preliminary because of the small number of patients and the observation that the weight gains were the same in the two groups.
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Southwest Pediatric Nephrology Study Group centers/participants
Baylor College of Medicine, Houston, Tex.
Phillip L. Berry, M. D., Andrea Forbes, R. N.
Baylor University Medical Center, Dallas, Tex.
Ronald J. Hogg, M. D., Tracy Shuck, R. N., Kaye Green
Tulane University Medical Center, New Orleans, La.
Frank Boineau, M. D., Karen Welling, R. N.
University of Arkansas, Little Rock, Ark.
Watson C. Arnold, M. D., Donna Floyd-Gimon, R.N.
University of Colorado, Denver, Colo.
Gary M. Lum, M.D., Leff Paulsen, R. N., Gail D'Amico, R. N.
University of Tennessee, Memphis, Tenn.
F. Bruder Stapleton, M. D., Patti Lawson, R. N., Judy Vinson, R. N.
University of Texas Medical Branch, Galveston, Tex.
Ben H. Brouhard, M. D., Lisa Hollander, R. N., Susan Gemma, R. D.
University of Texas Medical School, Houston, Tex.
Susan B. Conley, M. D., Ann Ince
University of Texas Southwestern Medical Center, Dallas, Tex.
Ricardo Uauy, M. D., Ph. D., Joan Reisch, Ph. D., Steven Alexander,
M. D., Nancy Simonds, R. N., Cynthia Cunningham, R. D.
University of Utah, Salt Lake City, Utah
Eileen Brewer, M. D., Miriam Turner, M. D., Jean Tealey, R. N.,
Greg Done, R. N., Patricia Reading, R. D., Cynthia Terrill, R. D.
University of California at San Francisco participants:
Malcolm Holliday, M. D., Jon Block, Ph. D., Martin Glasser, M. D.,
Jane Turner, Suzanne Young, R. N., Julie DuBois, R. N., Jon Hidayat, Jean Harrah
(Note that the location of the individual investigators reflects their institution during the time period of this study)
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Uauy, R.D., Hogg, R.J., Brewer, E.D. et al. Dietary protein and growth in infants with chronic renal insufficiency: a report from the Southwest Pediatric Nephrology Study Group and the University of California, San Francisco. Pediatr Nephrol 8, 45–50 (1994). https://doi.org/10.1007/BF00868260
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DOI: https://doi.org/10.1007/BF00868260