Here’s the GL @denisfouque1 refers to. VERY curious GL. Note it says for CKD 3-5ND patients and WITHOUT Diabetes. (What happens in Diabetics?) Is this really looking at all RCT’s of LPD's reporting ESRD or death? Let’s see the evidence cited...(a thread) https://twitter.com/denisfouque1/status/1391287666445066241

Here is the expert panels’ description and assessment of the data…to say it seems confusing is to be generous to a fault.

There are 5 RCT’s and only 3 are positive, but 1 of 3 negative (“borderline significant (P<0.06)” = “not significant (P>0.05). That means 3 of 5 are negative. But are there 5 trials? I count references to only 4. And the meta-analysis combined dates from only 3 studies? WTH?

A table in the supplements shows our 5 trials are:
ref 153 Locatelli 1991 n=456
161 Ciancianuso 2009 n=423
164 Hansen 2002; n=82
168 Rosman 1985 n=199
Trial 5? Ref 169! Rosman 1989! n=207 (paywalled!)
Do Rosman 1985 & 1989 share patients? KDOQI GL doesn't say that I could find.

Would you call “Cianciaruso et al (161)” “a relatively small sample size” when it is the 2nd largest trials reported by them? The KDOQI advocates for LPD did to wave away the negative result!

Gee, can I think of any OTHER LPD TPD that look at CKD progression and dialysis or death? Yes! The MDRD study (GFR 25 to 55!) study 1: n=585! Klahr NEJM 1994. it measured GFR!
The results? No difference in GFR decline over 3 years! No difference in deaths or dialysis!

And here is the MDRD study 2, n=255 measured GFR 13-24, randomized to LDP vs VLPD + supplements
There is no difference in rate of ESRD or death. What about UPD? They didn’t test it. True believers never do, IMO...

More reporting on death and dialysis in the MDRD trial....

And what about Diabetics? Well nevermind EBM – we will go with the opinions of our panel who are died in the wool advocates for LPD. BTW, “OPINION” largely means there is no evidence, or contrary evidence to support the opinions.

Now, I could go on and point out the workgroup (WG) have outstanding records investigating the benefits of LPD in CKD and dialysis patients, but that is just another reason why WG's shouldn't be judging their own data, and frankly, my Sundays are too precious to waste on this.