An opposite pattern was observed for progression of nephropathy. The authors note that the findings of the study are consistent with CVD studies and the role that SFAs may play in insulin sensitivity and other factors affecting diabetes control. Nonetheless, the authors consider that control of BP and blood glucose and cessation of smoking should remain the therapeutic objectives for modifiable risk factors. When these objectives are obtained, other measures such as encouraging PUFA and MIFA over SFA AZD0530 research buy may help prevent micro and macroalbuminuria.118 Table A5 presents a summary of the relevant studies found by the search strategy

in relation to dietary fat. With the exception of the study by Cardenas et al.118 discussed above, the studies are either of short duration and thus provide little useful evidence for the role of dietary fat in the progression of CKD. Relevant details of the studies are provided in Table A12. In summary, there are insufficient reliable studies to support a recommendation in relation to the prevention and management of CKD in people with type 2 diabetes. Intake

of protein in the usual range does not appear to be associated AZD2281 research buy with the development of CKD. However, long-term effects of consuming >20% of energy as protein on development of CKD has not been determined. Although diets high in protein and low in carbohydrate may produce short-term weight loss and improved glycaemic control, it has not been established that weight loss is maintained in the long term. There have been few prospective controlled studies of low protein diets in people with type 2 diabetes and kidney disease. The studies that have been performed have generally been deficient in experimental design, in methods for measuring kidney function and/or in duration of follow-up. Furthermore, the level of compliance with a low protein diet has not always been assessed objectively by urinary urea

nitrogen excretion. A particular criticism is that changes in the creatinine pool Clomifene and creatinine intake seen in low protein diet studies render measurements of creatinine clearance or the reciprocal of serum creatinine unreliable for the assessment of GFR.119 The objective of the systematic review was to assess the effects of dietary protein restriction on the progression of diabetic nephropathy in people with diabetes (type 1 and type 2 diabetes).120 The review identified 11 studies (9 RCTs and 2 before and after trials) where diet modifications were followed for at least 4 months. Before and after trials were included as it was considered that people could act as their own controls. Of these studies 8 were of people with type 1 diabetes, one type 2 diabetes and two included both type 1 and type 2 diabetes.