Rughooputh Mahesh Shumsher, Zeng Rui, Yao Ying
Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
PLoS One. 2015 Dec 28;10(12):e0145505. doi: 10.1371/journal.pone.0145505. eCollection 2015.
BACKGROUND/OBJECTIVE: Studies, including various meta-analyses, on the effect of Protein Diet Restriction on Glomerular Filtration Rate (GFR) in Chronic Kidney Disease (CKD) have reported conflicting results. In this paper, we have provided an update on the evidence available on this topic. We have investigated the reasons why the effect has been inconsistent across studies. We have also compared the effect on GFR in various subgroups including type 1 diabetics, type 2 diabetics and non-diabetics.
We searched for Randomized Controlled Trials on this intervention from MEDLINE, EMBASE, and other information sources. The PRISMA guidelines, as well as recommended meta-analysis practices were followed in the selection process, analysis and reporting of our findings. The effect estimate used was the change in mean GFR. Heterogeneity across the considered studies was explored using both subgroup analyses and meta-regression. Quality assessment was done using the Cochrane risk of bias tool and sensitivity analyses.
15 randomized controlled trials, including 1965 subjects, were analyzed. The pooled effect size, as assessed using random-effects model, for all the 15 studies was -0.95 ml/min/1.73m2/year (95% CI: -1.79, -0.11), with a significant p value of 0.03. The combined effect estimate for the non-diabetic and type 1 diabetic studies was -1.50 ml/min/1.73m2/year (95% CI: -2.73, -0.26) with p value of 0.02. The effect estimate for the type 2 diabetic group was -0.17 ml/min/1.73m2/year (95% CI: -1.88, 1.55) with p value of 0.85. There was significant heterogeneity across the included studies (I2 = 74%, p value for Q < 0.0001), explained by major variations in the percentage of type 2 diabetic subjects, the number of subjects and overall compliance level to diet prescribed.
Our findings suggest that protein diet restriction slows chronic renal disease progression in non-diabetic and in type 1 diabetic patients, but not in type 2 diabetic patients.
背景/目的：包括各种荟萃分析在内的关于蛋白质饮食限制对慢性肾脏病（CKD）患者肾小球滤过率（GFR）影响的研究报告了相互矛盾的结果。在本文中，我们提供了关于该主题现有证据的最新情况。我们调查了各项研究结果不一致的原因。我们还比较了蛋白质饮食限制对包括1型糖尿病患者、2型糖尿病患者和非糖尿病患者在内的不同亚组GFR的影响。
我们从MEDLINE、EMBASE和其他信息来源搜索了关于该干预措施的随机对照试验。在研究的选择、分析和报告过程中遵循了PRISMA指南以及推荐的荟萃分析方法。使用的效应估计值是平均GFR的变化。通过亚组分析和荟萃回归探讨了纳入研究之间的异质性。使用Cochrane偏倚风险工具进行质量评估并进行敏感性分析。
分析了15项随机对照试验，包括1965名受试者。使用随机效应模型评估，所有15项研究的合并效应大小为-0.95 ml/min/1.73m²/年（95%CI：-1.79，-0.11），p值为0.03，具有统计学意义。非糖尿病和1型糖尿病研究的合并效应估计值为-1.50 ml/min/1.73m²/年（95%CI：-2.73，-0.26），p值为0.02。2型糖尿病组的效应估计值为-0.17 ml/min/1.73m²/年（95%CI：-1.88，1.55），p值为0.85。纳入的研究之间存在显著异质性（I² = 74%，Q的p值<0.0001），这可以由2型糖尿病受试者的百分比、受试者数量以及对规定饮食的总体依从水平的重大差异来解释。
我们的研究结果表明蛋白质饮食限制可减缓非糖尿病患者和1型糖尿病患者慢性肾病的进展，但对2型糖尿病患者无效。
