ABSTRACT
Although long-term antihypertensive treatment has proved to reduce the average rate of decline in glomerular filtration rate (GFR) to approximately 5 ml/min/year [1] and improve survival in patients with diabetic nephropathy [27], the variation in rate of decline between individuals is still large, and these patients still have an increased mortality due to end-stage renal disease [ESRD] and cardio-vascular disease (CVD) as compared to patients without diabetic nephropathy [8]. New strategies for delaying the progression of renal failure and improving survival in patients with diabetic nephropathy are needed. Dietary protein restriction has long been advocated as a method for relieving symptoms in patients with advanced renal failure [9]. All major observational studies in type 1 and type 2 diabetic patients with diabetic nephropathy have failed to show an impact of dietary protein intake on the rate of decline in GFR [10-12]. However, since numerous experimental studies in animals [13-16] have suggested a beneficial effect of dietary protein restriction on survival and development of ESRD, new interest in dietary protein restriction as a strategy to retard the progression of chronic renal disease in man has been reawakened during the last 2 to 3 decades [17].
