Summary of findings 2. Very low versus low protein diet for people with CKD‐MBD.
| Very low versus low protein diet for people with CKD‐MBD | ||||||
| Patient or population: people with CKD‐MBD Settings: outpatient clinic Intervention: very low protein intake Comparison: low protein intake | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Very low protein diet | Low protein diet | |||||
| Serum phosphorus Follow‐up: 9 to 18 months | Mean serum phosphorus (control) 1.2 to 1.32 mmol/L | Mean serum phosphorus (intervention) 0.12 mmol/L lower (0.5 lower to 0.25 higher) | 41 (2) | ⊕⊝⊝⊝ very low1,2,3 | ||
| PTH Follow‐up: 9 to 18 months | Mean PTH (control) 23.11 to 139 pmol/L | Mean PTH (intervention) 9.98 pmol/L lower (12.85 to 7.1 lower) | 41 (2) | ⊕⊝⊝⊝ very low1,2,3 | ||
| Serum calcium Follow‐up: mean 9 months | Mean serum calcium (control) 2.3 mmol/L | Mean serum calcium (intervention) No higher (0.17 lower to 0.17 higher) | 22 (1) | ⊕⊝⊝⊝ very low1,4 | ||
| Alkaline phosphatase Follow‐up: mean 9 months | Mean alkaline phosphatase (control) 123 U/L | Mean alkaline phosphatase (intervention) 22 U/L lower (78.25 lower to 34.25 higher) | 22 (1) | ⊕⊝⊝⊝ very low1,4 | ||
| Mortality | Not reported | Not reported | Not estimable | ‐ | Not estimable | |
| Cardiovascular events | Not reported | Not reported | Not estimable | ‐ | Not estimable | |
| Fracture | Not reported | Not reported | Not estimable | ‐ | Not estimable | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (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 | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 The study reported using randomised controlled methods, but details of random sequence generation, allocation concealment and blinding were not reported 2 Very low protein intake (0.3 g/kg/d) showed a positive effect; low protein diet (0.4 g/kg/d) showed a negative effect. 3 Only published, small studies were included. Some negative results were reported. 4 Only one published study was included.