减少膳食钠摄入及DASH饮食对肾小球滤过率的影响：DASH-钠试验

Effects of Reduced Dietary Sodium and the DASH Diet on GFR: The DASH-Sodium Trial.

作者信息

Morales-Alvarez Martha Catalina, Nissaisorakarn Voravech, Appel Lawrence J, Miller Edgar R, Christenson Robert H, Rebuck Heather, Rosas Sylvia E, William Jeffrey H, Juraschek Stephen P

机构信息

Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

The Johns Hopkins Bloomberg School of Public Health, The Welch Center for Prevention, Epidemiology and Clinical Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.

出版信息

Kidney360. 2024 Apr 1;5(4):569-576. doi: 10.34067/KID.0000000000000390. Epub 2024 Feb 8.

DOI:10.34067/KID.0000000000000390

PMID:38326949

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11093532/

Abstract

KEY POINTS

Sodium reduction over a 4-week period decreased eGFR. Combining sodium reduction with the Dietary Approaches to Stop Hypertension diet resulted in larger reductions in eGFR. Changes in diastolic BP seem partially responsible for the observed dietary effects.

BACKGROUND

A potassium-rich Dietary Approaches to Stop Hypertension (DASH) diet combined with low sodium reduces BP. However, the effects of sodium reduction in combination with the DASH diet on kidney function are unknown. We determined the effects of sodium reduction and the DASH diet, on eGFR using cystatin C.

METHODS

DASH-sodium was a controlled, feeding study in adults with elevated or stage 1 hypertension, randomly assigned to the DASH or a control diet. On their assigned diet, participants consumed each of three sodium levels for 30 days after a 2-week run-in period of a high sodium-control diet. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). The primary outcome was change in eGFR based on cystatin C.

RESULTS

Cystatin C was measured in 409 of the original 412 participants, of which 207 were assigned the DASH diet and 202 to the control diet. Compared with control, the DASH diet did not affect eGFR (=−0.96 ml/min per 1.73 m; 95% confidence interval [CI], −2.74 to 0.83). By contrast, low versus high sodium intake decreased eGFR (=−2.36 ml/min per 1.73 m; 95% CI, −3.64 to −1.07). Together, compared with the high sodium-control diet, the low sodium-DASH diet decreased eGFR by 3.10 ml/min per 1.73 m (95% CI, −5.46 to −0.73). This effect was attenuated with adjustment for diastolic BP and 24-hour urinary potassium excretion.

CONCLUSIONS

A combined low sodium-DASH diet reduced eGFR over a 4-week period. Future research should focus on the effect of these dietary interventions on subclinical kidney injury and their long-term effect on progression to CKD.

CLINICAL TRIAL REGISTRATION NUMBER

ClinicalTrials.gov, NCT00000608.

摘要

要点

在4周内减少钠摄入会降低估算肾小球滤过率（eGFR）。将减少钠摄入与终止高血压膳食方法（DASH）饮食相结合，会使eGFR有更大幅度降低。舒张压的变化似乎部分导致了所观察到的饮食影响。

背景

富含钾的DASH饮食与低钠饮食相结合可降低血压。然而，减少钠摄入与DASH饮食相结合对肾功能的影响尚不清楚。我们使用胱抑素C确定了减少钠摄入和DASH饮食对eGFR的影响。

方法

DASH-钠研究是一项针对高血压前期或1期高血压成年人的对照喂养研究，参与者被随机分配到DASH饮食组或对照饮食组。在按指定饮食进行的高钠对照饮食2周导入期后，参与者在各自指定饮食下，分别食用三种钠水平的食物各30天。这三种钠水平分别为低（50 mmol/d）、中（100 mmol/d）和高（150 mmol/d）。主要结局是基于胱抑素C的eGFR变化。

结果

在最初的412名参与者中，对409人进行了胱抑素C检测，其中207人被分配到DASH饮食组，202人被分配到对照饮食组。与对照组相比，DASH饮食对eGFR没有影响（平均变化=-0.96 ml/min/1.73 m²；95%置信区间[CI]，-2.74至0.83）。相比之下，低钠摄入与高钠摄入相比降低了eGFR（平均变化=-2.36 ml/min/1.73 m²；95% CI，-3.64至-1.07）。总体而言，与高钠对照饮食相比，低钠-DASH饮食使eGFR降低了3.10 ml/min/1.73 m²（95% CI，-5.46至-0.73）。在对舒张压和24小时尿钾排泄进行校正后，这种影响减弱。