Thirty-four patients with chronic renal insufficiency were instructed to subsist on a 20-gm balanced lowprotein diet during a 21-month study period. There was a 22% incidence of inability to follow this strict regimen. Patients who adhered to the diet and had adequate renal function as judged by urea nitrogen clearance of greater than 1.5 cc/min experienced improvement in uremic symptoms. Complications of this regimen included hyperkalemia and edema. Metabolic acidosis was prevented by the use of orally administered calcium carbonate supplements. Return of uremic symptoms generally occurred when urea nitrogen clearance decreased below 1.5 to 1.0 cc/min or when urine volume decreased below 1 liter/24 hr. The duration of remission from uremic symptoms depends on prevention of deterioration in renal function and cooperation of the patients in adhering to this special diet.
Franklin SS, Gordon A, Kleeman CR, Maxwell MH. Use of a Balanced Low-Protein Diet in Chronic Renal Failure. JAMA. 1967;202(6):477-484. doi:10.1001/jama.1967.03130190083011