A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function

Dietary protein restriction has been reported to delay the need for renal replacement therapy in clinical trials and meta-analyses. However, less clear is what effect dietary protein has on the rate of decline in renal function. We pooled the results of 13 randomized controlled trials (n = 1,919 patients) and found that dietary protein restriction reduced the rate of decline in estimated glomerular filtration rate by only 0.53 mL/min/yr (95% confidence interval [CI], 0.08 to 0.98 mL/min/yr). We also used weighted regression analysis to determine the reasons for the differences in the results of these 13 randomized trials along with 11 other nonrandomized controlled trials (n = 2,248 patients). The effect of dietary protein restriction (glomerular filtration rate decline in treatment minus control) was substantially less in randomized versus nonrandomized trials (regression coefficient, -5.2 mL/min/yr; 95% CI, -7.8 to -2.5 mL/min/yr; P < 0.05) and relatively greater among diabetic versus nondiabetic patients (5.4 mL/min/yr; 95% CI, 0.3 to 10.5 mL/min/yr; P < 0.05), while there was a trend toward a greater effect with each additional year of follow-up (2.1 mL/min/yr; 95% CI, -0.05 to 4.2 mL/min/yr; P = NS). However, the number of diabetic patients studied was small and the duration of follow-up was short in most trials. No other patient or study characteristics altered the effect of dietary protein restriction on the rate of decline in renal function. Thus, although dietary protein restriction retards the rate of renal function decline, the relatively weak magnitude of this effect suggests that better therapies are needed to slow the rate of renal disease progression.

The effects of dietary protein restriction on chronic progressive renal disease

There have been a large number of clinical trials and two meta-analyses attempting to determine if dietary protein restriction retards the rate of renal disease progression. Indeed, in a systematic search of prospective, controlled trials examining the effects of protein restriction over at least 6 months, we located 23 published between 1980 and 1996. Only 12 of these trials were randomized and controlled. The results of the 23 studies were heterogeneous. Two meta-analyses combined the results of randomized, controlled trials. Although both meta-analyses concluded that dietary protein restriction significantly reduced the number of patients who died or required treatment for end-stage renal disease, the well-known effects of protein restriction on the signs and symptoms of uremia leave open the question of whether protein restriction had a substantial effect on renal disease progression per se. Adding to the uncertainty is the inconclusive result of the largest, best-designed clinical trial, the Modification of Diet in Renal Disease Study. In any case, the effect of protein restriction on the rate of decline in renal function is arguably modest, making it difficult to demonstrate statistical significance, even in large, well-designed clinical trials. All of these trials suggest that we need therapies that are more effective than dietary protein restriction to halt the progression of renal disease.

Identification of the major glycosyl-phosphatidylinositol anchored proteins on the surface of human neutrophils

A novel mechanism of protein attachment to cell membranes involving the covalent linkage of the protein through an oligosaccharide to phosphatidylinositol has recently been defined. Many proteins that are anchored to the cell membrane by this mechanism can be released by treatment with phosphatidylinositol-specific phospholipase C (PI-PLC). Monoclonal antibodies are useful as probes in the study of the roles of cell-surface components in neutrophil function. Many monoclonal antibodies that bind to human neutrophils react with the oligosaccharide lacto-N-fucopentaose III (CD15 antibodies). Human neutrophil surface proteins identified by 125I surface-labeling using lactoperoxidase were examined for PI-PLC sensitivity, to identify the major surface proteins of human neutrophils that are anchored by a glycosyl-phosphatidylinositol linkage. The major surface-labeled protein identified by lactoperoxidase-catalyzed iodination was a approximately 68-90-kDa protein. Three major surface proteins identified by 125I-surface labeling of approximately 68-90, 57, and 33-kDa were released by PI-PLC treatment. Immunoprecipitation and subsequent gel electrophoresis of proteins from neutrophils labeled with 125I revealed a previously unidentified 98-115-kDa protein specifically reactive with CD15 antibodies that was released from the cell by treatment with PI-PLC. The roles of these proteins in neutrophil function remain to be determined.