Observational studyNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association2024
The safety of a low-protein diet in older adults with advanced chronic kidney disease.
Observational study in Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 11 citations in OpenAlex.
- Article
- Deciding between conservative kidney management and dialysis in older people with kidney failure: a narrative review.Clinical kidney journal · 2026Review
- Dietary Protein Intake in CKD: Quantity and Quality.Clinical journal of the American Society of Nephrology : CJASN · 2026Review
- Article
- Antiobesity Medications for Older Adults-the New, the Good, the Bad, and the Unknown.Obesity (Silver Spring, Md.) · 2025Review
- Low-protein diet for chronic kidney disease: Evidence, controversies, and practical guidelines.Journal of internal medicine · 2025Review
- Dietary Protein Intake Recommendations for Patients with Non-Dialysis-Dependent CKD: What Should Healthcare Providers Do?Clinical journal of the American Society of Nephrology : CJASN · 2025Review
- Trends in the burden of chronic kidney disease related to high red meat intake from 1990 to 2021.BMC public health · 2025Article
- Low-Protein Diets Could Be Effective and Safe in Elderly Patients with Advanced Diabetic Kidney Disease.Nutrients · 2024Article
- Prevention of Chronic Kidney Disease and Its Complications in Older Adults.Drugs & aging · 2024Review
Corrections and comments
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Authors and funding
18 authors at 10 institutions in 6 countries.
Funding
Abstract
backgroundA low-protein diet (LPD) is recommended to patients with advanced chronic kidney disease (CKD), whereas geriatric guidelines recommend a higher amount of protein. The aim of this study was to evaluate the safety of LPD treatment in older adults with advanced CKD.
methodsThe EQUAL study is a prospective, observational study including patients ≥65 years of age with an incident estimated glomerular filtration rate <20 ml/min/1.73 m2 in six European countries with follow-up through 6 years. Nutritional status was assessed by a 7-point subjective global assessment (SGA) every 3-6 months. Prescribed diet (g protein/kg of bodyweight) was recorded on every study visit; measured protein intake was available in three countries. Time to death and decline in nutritional status (SGA decrease of ≥2 points) were analysed using marginal structural models with dynamic inverse probability of treatment and censoring weights.
resultsOf 1738 adults (631 prescribed LPD at any point during follow-up), there were 1319 with repeated SGA measurements, of which 267 (20%) decreased in SGA ≥2 points and 565 (32.5%) who died. There was no difference in survival or decrease in nutritional status for patients prescribed a LPD ≤0.8 g/kg ideal bodyweight {odds ratio [OR] for mortality 1.15 [95% confidence interval (CI) 0.86-1.55)] and OR for decrease in SGA 1.11 [95% CI 0.74-1.66]} in the adjusted models. In patients prescribed a LPD <0.6 g/kg ideal bodyweight, the results were similar. There was a significant interaction with LPD and older age >75 years, lower SGA and higher comorbidity burden for both mortality and nutritional status decline.
conclusionsIn older adults with CKD approaching end-stage kidney disease, a traditional LPD prescribed and monitored according to routine clinical practice in Europe appears to be safe.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.