Summary of findings 2. Very low protein diet versus low or normal protein diet for non‐diabetic adults with chronic kidney disease (CKD).
| Very low protein diet versus low or normal protein diet for non‐diabetic adults with CKD | |||||
| Patient or population: non‐diabetic adults with CKD Setting: all settings Intervention: Very low protein diet Comparison: low or normal protein diet | |||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | |
| Risk with low or normal protein diet | Risk with very low protein diet | ||||
| Death (all causes) | 39 per 1,000 | 49 per 1,000 (24 to 99) | RR 1.26 (0.62 to 2.54) | 681 (6) | ⊕⊕⊕⊝ MODERATE 1 |
| ESKD | 458 per 1,000 | 293 per 1,000 (225 to 389) | RR 0.64 (0.49 to 0.85) | 1010 (10) | ⊕⊕⊕⊝ MODERATE 2 |
| End or change in GFR | The SMD for end or change in GFR was 0.12 (0.27 lower to 0.52 higher) with very low protein diet compared to low or normal protein diet | ‐ | 456 (6) | ⊕⊕⊝⊝ LOW 1 2 3 4 | |
| *The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; ESKD: end‐stage kidney disease; GFR: glomerular filtration rate; SMD ‐ standardised mean difference | |||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | |||||
1 The confidence intervals are wide and include potential for important benefits and harms
2 Serious unexplained heterogeneity
3 Outcome is a surrogate outcome
4 Unclear allocation concealment in 4 studies contributing information to analysis