A Low-Iron-Available, Polyphenol-Enriched, Carbohydrate-Restricted Diet to Slow Progression of Diabetic Nephropathy

  1. Francesco S. Facchini12 and
  2. Kami L. Saylor2
  1. 1Department of Medicine, Division of Nephrology, San Francisco General Hospital and University of California, San Francisco, California
  2. 2Department of Medicine, Division of Nephrology, Kaiser Foundation Hospitals & the Permanente Medical Group, Inc., Oakland, California


    Diabetic nephropathy has become the leading cause of uremia. Several lines of evidence suggest dietary factors other than protein intake have a substantial role in the progression of diabetic nephropathy to end-stage renal disease. The present investigation was initiated to evaluate whether a carbohydrate-restricted, low-iron-available, polyphenol-enriched (CR-LIPE) diet may delay and improve the outcome of diabetic nephropathy to a greater extent than standard protein restriction. To this aim, 191 diabetic patients, all with type 2 diabetes, were randomized to either CR-LIPE or standard protein restriction and the following outcomes monitored: doubling of serum creatinine, cumulative incidence of end-stage renal disease, and all cause mortality. Over a mean follow-up interval of 3.9 ± 1.8 years, serum creatinine concentration doubled in 19 patients on CR-LIPE (21%) and in 31 control subjects (39%) (P < 0.01). Renal replacement therapy or death occurred in 18 patients on CR-LIPE (20%) and in 31 control subjects (39%) (P < 0.01). These differences were independent from follow-up interval, sex, mean arterial blood pressure, HbA1c, initial renal dysfunction, and angiotensin system inhibitor use. In conclusion, CR-LIPE was 40–50% more effective than standard protein restriction in improving renal and overall survival rates.


    • Address correspondence and reprint requests to Francesco S. Facchini, MD, Box 1341 UCSF, San Francisco, CA 94143-1341. E-mail: fste2000{at}

      Received for publication 6 September 2002 and accepted in revised form 21 January 2003.

      ASI, angiotensin system inhibition; CHO, carbohydrate; CR-LIPE, carbohydrate-restricted, low-iron-available, polyphenol-enriched; ESRD, end-stage renal disease; GFR, glomerular filtration rate; MAP, mean arterial pressure; RRT, renal replacement therapy.

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