The Modification of Diet in Renal Disease Study

For reasons that are unknown, chronic kidney failure of diverse causes tends to progress to end-stage renal disease. Several hypotheses have been advanced to explain the mechanisms by which renal insufficiency progresses,1 2 3 but none have been definitely established.1 Studies in animals4 and clinical trials in humans5 6 7 with chronic renal disease suggest that the dietary restriction of protein and phosphorus may slow the rate of progression. However, the trials of low-protein, low-phosphorus diets in humans have generally been deficient with respect to experimental design. The deficiencies include the lack of proper randomization procedures, absence or inappropriateness of control populations, use of . . .