Malvy 1999.

Methods	Study design: parallel RCT Study duration: January 1983 to May 1987 Study follow‐up period: 3 to 35 months
Participants	Country: France Setting: multicentre (two sites) Patients with CKD with GFR < 19 mL/min/1.73 m2 (calculated by Cockcroft formula) Number: very low protein diet group (25); low protein diet group (25) Mean age ± SD (years): very low protein diet group (53.8 ± 11); low protein diet group (56.0 ± 14) Sex (M/F): very low protein diet group (14/11); low protein diet group (15/10) Exclusion criteria: DM; cancer; systemic disease; obstructive uropathy; RPGN; lethal disease
Interventions	Very low protein diet group Protein intake: 0.3 g protein/kg/d Oral keto acid supplement (Ketosteril 1 tab/6 kg/d): 0.17 g/kg/d Calculated protein intake: 0.58 g/kg/d Low protein diet group Protein intake: 0.6 g protein/kg/d Calculated protein intake: 0.79 g/kg/d Co‐interventions Vitamin supplements, antihypertensive medications
Outcomes	ESKD: CrCl < 5 mL/min/1.73 m2 or uraemic intolerance diagnosed by two nephrologists and requiring dialysis Weight, lean body mass, fat body mass Death (all causes)
Notes	Information on numbers reaching ESKD provided by Dr Bagros Funding source: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information to permit judgement
Allocation concealment (selection bias)	Unclear risk	Insufficient information to permit judgement
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not blinded and lack of blinding may influence patient management
Blinding of outcome assessment (detection bias): End or change in GFR End of change in GFR	Low risk	Primary outcome of CrCl based on laboratory outcome so unlikely to be influenced by lack of blinding
Blinding of outcome assessment (detection bias): Need to start dialysis Need to start dialysis	Low risk	GFR < 5 mL/min/1.73 m2 estimated from (CrCl + urea clearance)/2 or uraemic symptoms requiring dialysis as determined by 2 nephrologists
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Unclear whether all participants included in outcome measurement
Selective reporting (reporting bias)	High risk	Numbers reaching GFR endpoint only available graphically
Other bias	Unclear risk	Insufficient information to permit judgement