RESUMEN
Objective:To systematically evaluate the effects of protein restriction, low-sodium diet and alkaline diet on renal outcomes, the rate of change in estimated glomerular filtration rate (eGFR) and all-cause mortality in chronic kidney disease (CKD) patients.Methods:Three main databases, Ovid, EMBASE and the Cochrane Library database, were searched for randomized controlled trials about the effects of protein restriction, alkaline diet, low-sodium diet in chronic kidney disease. The primary outcome was renal composite endpoint events, the annual rate of change in eGFR and all-cause mortality. Renal composite endpoint events was defined as >25% or 50% decrease from baseline in eGFR, doubling of serum creatinine, or the development of end-stage renal diseaseas during follow-up.The studies were selected according to inclusion and exclusion criteria and assessed for quality using Jadad Scale. Two investigators were chosen to search, extract and evaluate the data independently. Software Stata 16.0 and RevMan 5.4 were used for meta-analysis.Results:A total of 34 studies with 5 589 participants were included. Protein restriction ( RR = 0.78, 95% CI: 0.64 to 0.96, P < 0.001), alkaline diet ( RR = 0.64, 95% CI: 0.43 to 0.98, P < 0.001) and low-sodium diet ( RR = 0.45, 95% CI: 0.28 to 0.73, P < 0.01) reduced the risk of renal composite outcomes. Protein restriction ( MD = 1.85, 95% CI: 0.77 to 2.93, P = 0.001), alkaline diet ( MD = 1.45, 95% CI: 0.53 to 2.37, P < 0.001) and low-sodium diet ( MD = 1.84, 95% CI: 1.06 to 2.63, P < 0.001) also decreased the rate of delince in eGFR. But these dietary patterns did not show a clear beneficial effect for all-cause mortality ( RR = 1.15, 95% CI: 0.76 to 1.73, P = 0.167 for protein restriction, RR = 0.96, 95% CI: 0.31 to 3.02, P = 0.546 for alkaline diet and RR = 0.82, 95% CI: 0.48 to 1.40, P = 0.057 for low-sodium diet). Conclusion:The three dietary interventions may decline the rate of renal function exacerbation and decrease the risk of unfavourable renal outcomes in CKD patients, while have no clear beneficial effect on all-cause mortality.
RESUMEN
Resumen La prevalencia de diabetes mellitus tipo 2 (DM2) está en aumento, generando un gran impacto tanto a nivel individual como en salud pública. Cerca de la mitad de los pacientes con DM2 sufren un deterioro de la función renal, por esto la nefroprotección resulta de fundamental importancia. El conjunto de evidencia que cambió del enfoque terapéutico glucocéntrico al cardiorrenometabólico en la DM2 motivó la inclu sión en las recomendaciones internacionales de nuevas terapias con beneficios cardiovasculares y renales. Los agonistas del receptor del péptido similar al glucagón tipo 1 (GLP-1) tienen efectos favorables sobre la función renal y sus posibles acciones protectoras son multifactoriales, más allá del control glucémico. Estos beneficios han sido demostrados en los estudios clínicos de eficacia y seguridad, así como también en los estudios de re sultados cardiovasculares y de vida real. En esta revisión narrativa se describen los efectos directos e indirectos de estas moléculas, así como su evidencia en los principales estudios clínicos (LEADER, SUSTAIN 6 y REWIND) y de vida real que demuestran sus efectos beneficiosos sobre la función renal e introduce la expectativa de los resultados futuros de los estudios en curso con objetivos renales.
Abstract The prevalence of type 2 diabetes mellitus (DM2) is increasing, generating a great impact both at individual and public health level. Nearly half of the patients with DM2 develop impaired renal function, so nephron-protection is highly important. The robust body of evidence that shifted the therapeutic focus from glycemic to cardio-renal metabolic therapy in DM2 led to the inclusion of new therapies with cardiovascular and renal benefits in international guidelines. Type 1 glucagon (GLP-1) receptor agonists have showed favorable effects on renal function and their potential protective actions are multifactorial, beyond glycemic control. These benefits have been demonstrated in efficacy and safety clini cal studies, as well as in cardiovascular outcomes and real-life studies. This comprehensive review describes the direct and indirect effects of these molecules, as well as evidence obtained from pivotal clinical (LEADER, SUSTAIN 6 and REWIND) and real-life studies demonstrating their beneficial effects on renal function, and also introduces expectations of future results from ongoing studies with renal endpoints.