Effects of a Low-Protein Diet on Kidney Function in Patients With Chronic Kidney Disease: An Umbrella Review of Systematic Reviews and Meta-analyses of Randomized Controlled Trials.
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Abstract
Context: Chronic kidney disease (CKD) stands out as one of the most widespread diseases globally. Dietary interventions, such as adopting a low-protein diet (LPD), play a crucial role as a key approach in impeding the advancement of CKD.
Objective: The objective of this umbrella review was to provide understanding into the effects of an LPD on kidney function among individuals with CKD, along with evaluating the certainty of the available evidence.
Data sources: Searches for relevant studies were conducted without limitations through databases such as PubMed, Scopus, Web of Science, and Google Scholar, encompassing findings up to June 2023.
Data extraction: The effect sizes for each meta-analysis were recalibrated using a random-effects model. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
Data analysis: Twenty-five meta-analyses including 47 randomized controlled trials were included in this study. Moderate certainty of the evidence suggests that LPDs may reduce glycated hemoglobin (HbA1c) and phosphorus levels, and the risk of progressing to end-stage renal disease in patients with CKD. Moreover, notable outcomes include increased glomerular filtration rate and decreased levels of serum albumin, blood urea nitrogen, and bicarbonate, although the certainty of evidence is low. In addition, LPDs can substantially decrease proteinuria, urine urea, and parathyroid hormone (PTH), although with very low certainty. The effects on serum creatinine, calcium, systolic blood pressure, and diastolic blood pressure are statistically nonsignificant, with the certainty of evidence ranging from low to moderate.
Conclusion: LPDs demonstrated beneficial effects on renal function in patients with CKD, which is supported by moderate to very low certainty evidence.
背景：慢性肾脏疾病（CKD）是全球最普遍的疾病之一。饮食干预，如采用低蛋白饮食（LPD），在阻碍CKD进展的关键途径中起着至关重要的作用。目的：本综述的目的是了解LPD对CKD患者肾功能的影响，并评估现有证据的确定性。数据来源：通过PubMed、Scopus、Web of Science、b谷歌Scholar等数据库无限制地检索相关研究，涵盖截至2023年6月的研究结果。数据提取：使用随机效应模型重新校准每个meta分析的效应量。证据的确定性采用分级推荐评估、发展和评价（GRADE）方法进行评估。资料分析：纳入25项meta分析，47项随机对照试验。中度确定性的证据表明，lpd可能降低CKD患者糖化血红蛋白（HbA1c）和磷水平，以及进展为终末期肾脏疾病的风险。此外，值得注意的结果包括肾小球滤过率增加，血清白蛋白、血尿素氮和碳酸氢盐水平降低，尽管证据的确定性很低。此外，lpd可以显著减少蛋白尿、尿尿素和甲状旁腺激素（PTH），尽管确定性很低。对血清肌酐、钙、收缩压和舒张压的影响在统计学上不显著，证据的确定性从低到中等。结论：lpd对CKD患者的肾功能有有益的影响，这是由中等到极低的证据支持的。系统评审注册：普洛斯彼罗注册号。CRD42023473647。
期刊介绍：
Nutrition Reviews is a highly cited, monthly, international, peer-reviewed journal that specializes in the publication of authoritative and critical literature reviews on current and emerging topics in nutrition science, food science, clinical nutrition, and nutrition policy. Readers of Nutrition Reviews include nutrition scientists, biomedical researchers, clinical and dietetic practitioners, and advanced students of nutrition.
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