A systematic review on the effects of dietary management in chronic kidney disease / 中华临床营养杂志

ABSTRACT

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.