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Original ArticlesClinical Nephrology
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Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney

Allon N. Friedman, Lorraine G. Ogden, Gary D. Foster, Samuel Klein, Richard Stein, Bernard Miller, James O. Hill, Carrie Brill, Brooke Bailer, Diane R. Rosenbaum and Holly R. Wyatt
CJASN July 2012, 7 (7) 1103-1111; DOI: https://doi.org/10.2215/CJN.11741111
Allon N. Friedman
*Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana;
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Lorraine G. Ogden
†Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Denver, Colorado;
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Gary D. Foster
‡Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania;
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Samuel Klein
§Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; and
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Richard Stein
§Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; and
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Bernard Miller
§Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; and
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James O. Hill
‖Anschutz Health & Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Carrie Brill
‖Anschutz Health & Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Brooke Bailer
‡Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania;
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Diane R. Rosenbaum
‡Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania;
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Holly R. Wyatt
‖Anschutz Health & Wellness Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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    Figure 1.

    Flow diagram of participant recruitment.

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    Figure 2.

    Trends in creatinine clearance. Bars represent 95% confidence interval for means.

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    Figure 3.

    Trends in urinary calcium excretion. Bars represent 95% confidence interval for means.

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    Table 1.

    Baseline characteristics

    CharacteristicLow-Fat Diet (n=154)Low-Carbohydrate Diet (n=153)
    Age (yr)44.9±10.246.2±9.2
    Men, n (%)49 (31.8)50 (32.7)
    Race, n (%)
     white117 (76.0)113 (73.9)
     African American33 (21.4)36 (23.5)
     Asian2 (1.3)0 (0)
     other2 (1.3)4 (2.6)
    Weight (kg)103.7±14.4103.6±15.5
    Body mass index (kg/m2)36.1±3.536.1±3.6
    Systolic BP (mmHg)124.6±15.8124.3±14.1
    Diastolic BP (mmHg)76.0±9.773.9±9.4
    Serum creatinine (mg/dl)a0.9 (0.8, 1.0)0.8 (0.7,1.0)
    Serum cystatin C (mg/L)a0.7 (0.6, 0.8)0.7 (0.6, 0.8)
    Serum electrolytes
     sodium (mmol/L)139±2.3140±2.5
     potassium (mmol/L)4±0.44±0.3
     chloride (mmol/L)105±2.6105±2.1
     bicarbonate (mmol/L)24±2.624±2.4
    Urea (mg/L)a13 (10, 15)14 (11, 16)
    Urine measurements
     total volume (ml)2012±10791940±1159
     creatinine (mg/24 hr)a1630 (1300, 1980)1585 (1276, 2085)
     calcium (mg/24 hr)a207 (110, 278)187 (117, 278)
     albumin (mg/24 hr)a7 (6, 14)9 (6, 15)
     24-hr creatinine clearance (ml/min)133±41.8135±35.3
    • Data reported as mean ± SD unless otherwise indicated. There were no significant differences between groups for any of the variables.

    • ↵a Data reported as median (25th, 75th percentiles).

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    Table 2.

    Estimated change from baseline in dietary study groups

    VariableLow-Carbohydrate DietLow-Fat Diet
    Study MonthStudy Month
    3122431224
    Participants (n)
     serum measurements1361117414011683
     urine measurements11178561097766
    Weight (kg)−9.70a (−10.40 to −9.00)−11.20 (−12.50 to −9.90)−6.60 (−8.20 to −4.90)−8.40 (−9.10 to −7.50)−10.50 (−12.60 to −9.20)−7.80 (−9.60 to −6.10)
    Serum creatinine (%)b−2.40c (−4.80 to −0.10)−3.10 (−5.50 to −0.60)0.10 (−3.10 to 3.40)1.90 (−0.40 to 4.20)−0.42 (−2.90 to 2.10)−1.64 (−4.10 to 0.90)
    Serum cystatin C (%)b−9.50d(−11.10 to −7.80)−4.80 (−6.80 to −2.90)−1.00 (−3.40 to 1.50)−1.10 (−2.80 to 0.60)−3.20 (−4.90 to −1.60)−0.90 (−2.80 to 1.00)
    Serum sodium (mmol/L)−0.10 (−0.50 to 0.30)−0.50 (−1.00 to −0.10)−0.40 (−1.00 to 0.10)0.40 (−0.00 to 0.80)−0.30 (−0.70 to 0.20)0.20 (−0.20 to 0.70)
    Serum potassium (mmol/L)−0.02 (−0.10 to 0.00)−0.06 (−0.10 to −0.00)−0.05 (−0.10 to 0.00)−0.07 (−0.10 to −0.00)0.003 (−0.10 to 0.10)−0.03 (−0.10 to 0.10)
    Serum chloride (mmol/L)−0.40 (−0.90 to −0.00)0.06 (−0.40 to 0.50)0.06 (−0.50 to 0.60)0.08 (−0.30 to 0.50)0.15 (−0.30 to 0.60)0.19 (−0.30 to 0.70)
    Serum bicarbonate (mmol/L)−0.50 (−0.90 to −0.10)0.70 (0.30–1.10)0.50 (−0.10 to 1.00)−0.20 (−0.60 to 0.20)0.60 (0.10–1.10)0.50 (0.00–1.00)
    Serum urea nitrogen (%)b13.00d (8.30–17.90)14.20c (9.50–19.20)9.50a (3.10–16.30)−1.20 (−5.00 to 2.70)4.80 (0.20–9.60)1.20 (−3.70 to 6.30)
    Urinary volume (ml/d)249.00 (79.00–418.00)487.00c (296.00–678 .00)228.00a (18.00–438.00)24.00 (−183.00 to 231.00)49.00 (−124.00 to 222.00)−40.00 (−205.00 to 125.00)
    Urinary creatinine (%)b−3.40 (−9.90 to 3.60)−0.70 (−6.00 to 4.90)−2.90 (−8.90 to 3.60)−7.90 (−13.10 to −2.50)−8.40 (−14.70 to −1.70)−5.90 (−12.80 to 1.50)
    Creatinine clearance (ml/min)5.20c (−3.30 to 13.70)10.10c (1.50–18.70)3.70 (−6.70 to 14.10)−10.60 (−18.30 to −2.90)−10.70 (−20.00 to −1.30)−3.50 (−15.10 to 8.10)
    Urinary albumin (%)b−5.80 (−20.40 to 11.40)−7.10 (−24.80 to 14.80)−21.40 (−35.00 to −5.00)−11.30 (−26.50 to 7.10)−22.20 (−38.30 to −1.90)−23.80 (−38.10 to −6.20)
    Urinary calcium (%)b20.90d (7.20–36.40)26.90c (11.50–44.50)7.30 (−7.10 to 23.90)−11.20 (−21.10 to −0.10)−6.50 (−19.90 to 9.30)−9.80 (−22.10 to 4.50)
    • Estimated using a linear mixed-effects model. Data reported as absolute changes from baseline (estimated mean with 95% confidence interval) unless otherwise indicated.

    • ↵a P<0.05 for difference between the two diets at specified time.

    • ↵b Log-transformed for analysis with back-transformed data reported as percentage change (95% confidence interval).

    • ↵c P<0.01 for difference between the two diets at specified time.

    • ↵d P<0.001 for difference between the two diets at specified time.

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Clinical Journal of the American Society of Nephrology: 7 (7)
Clinical Journal of the American Society of Nephrology
Vol. 7, Issue 7
July 06, 2012
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Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney
Allon N. Friedman, Lorraine G. Ogden, Gary D. Foster, Samuel Klein, Richard Stein, Bernard Miller, James O. Hill, Carrie Brill, Brooke Bailer, Diane R. Rosenbaum, Holly R. Wyatt
CJASN Jul 2012, 7 (7) 1103-1111; DOI: 10.2215/CJN.11741111

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Comparative Effects of Low-Carbohydrate High-Protein Versus Low-Fat Diets on the Kidney
Allon N. Friedman, Lorraine G. Ogden, Gary D. Foster, Samuel Klein, Richard Stein, Bernard Miller, James O. Hill, Carrie Brill, Brooke Bailer, Diane R. Rosenbaum, Holly R. Wyatt
CJASN Jul 2012, 7 (7) 1103-1111; DOI: 10.2215/CJN.11741111
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