Li Qiuling, Wen Feng, Wang Yanhui, Li Sheng, Lin Shaochun, Qi Chunfang, Chen Zujiao, Qiu Xueqian, Zhang Yifan, Zhang Shaogui, Tao Yiming, Feng Zhonglin, Li Zhilian, Li Ruizhao, Ye Zhiming, Liang Xinling, Liu Shuangxin, Xie Jianteng, Wang Wenjian
Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
Shantou University Medical College, Shantou, 515041, China.
Diabetes Ther. 2021 Jan;12(1):21-36. doi: 10.1007/s13300-020-00952-5. Epub 2020 Nov 4.
A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) actually benefit from a DPI of ≤ 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1-3 has not been consistent. We systematically searched MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, as well as the bibliographies of articles identified in the search, for eligible randomized controlled trials that had investigated the effects of LPD (prescribed DPI < 0.8 g/kg/day) versus control diet on the progression of DKD. Nine trials that included 506 participants and follow-up periods varying from 4.5 to 60 months were included in the subsequent systematic review and meta-analysis. The data showed that patients with DKD who consumed < 0.8 g protein/kg/day had a significantly reduced decline in glomerular filtration rate (GFR) (mean difference [MD] 22.31 mL/min/1.73 m, 95% confidence interval [CI] 17.19, 27.42; P < 0.01) and a significant decrease in proteinuria (standard mean difference [SMD] - 2.26 units, 95% CI - 2.99, - 1.52; P < 0.001) versus those on the control diet. The benefits of LPD to patients with DKD at CKD stages 1-3 were a markedly decreased proteinuria (SMD - 0.96 units, 95% CI - 1.81, - 0.11; P = 0.03) and slight but significant decreases in glycated hemoglobin (- 0.42%) and cholesterol levels (- 0.22 mmol/L). Our meta-analysis indicated that a DPI of < 0.8 g/kg/day was strongly associated with a slow decline in GFR and decreased proteinuria in the patients with DKD. Patients with CKD stages CKD 1-3 benefited from LPD in terms of a marked decrease of proteinuria and slight but significant improvements in lipid and glucose control.
对于中重度慢性肾脏病（CKD）成人患者，通常建议每日膳食蛋白质摄入量（DPI）为每千克体重0.6至0.8克蛋白质（克/千克/天）。然而，关于糖尿病肾病（DKD）患者在CKD 1 - 3期是否真的能从≤0.8克/千克/天的DPI及低蛋白饮食（LPD）中获益，证据并不一致。我们系统检索了MEDLINE、EMBASE、Cochrane图书馆、Web of Knowledge以及检索中所识别文章的参考文献，以查找符合条件的随机对照试验，这些试验研究了LPD（规定的DPI < 0.8克/千克/天）与对照饮食对DKD进展的影响。随后的系统评价和荟萃分析纳入了9项试验，共506名参与者，随访期从4.5个月至60个月不等。数据显示，与接受对照饮食的患者相比，每日摄入蛋白质< 0.8克/千克的DKD患者肾小球滤过率（GFR）下降显著减少（平均差值[MD] 22.31毫升/分钟/1.73平方米，95%置信区间[CI] 17.19，27.42；P < 0.01），蛋白尿也显著降低（标准平均差值[SMD] - 2.26单位，95% CI - 2.99， - 1.52；P < 0.001）。LPD对CKD 1 - 3期DKD患者的益处包括蛋白尿显著减少（SMD - 0.96单位，95% CI - 1.81， - 0.11；P = 0.03），糖化血红蛋白（- 〇.42%）和胆固醇水平（- 〇.22毫摩尔/升）有轻微但显著的降低。我们的荟萃分析表明，< 0.8克/千克/天的DPI与DKD患者GFR缓慢下降及蛋白尿减少密切相关。CKD 1 - 3期患者从LPD中获益，表现为蛋白尿显著减少，脂质和血糖控制有轻微但显著的改善。
