Mahboobi Sepideh, Mollard Rebecca, Tangri Navdeep, Askin Nicole, Ferguson Thomas, Rahman Tahmina, Rabbani Rasheda, Abou-Setta Ahmed M, MacKay Dylan
Department of Human Nutritional Sciences, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Chronic Disease Innovation Center, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Nephrol Dial Transplant. 2025 Apr 1;40(4):751-767. doi: 10.1093/ndt/gfae200.
Metabolic acidosis is a common complication of kidney disease and can result in further disease progression. Alkali therapy has been used to treat metabolic acidosis for decades. However, some concerns have been raised regarding its safety and long-term tolerability. Existing data suggest that dietary interventions can be beneficial in the management of chronic kidney disease (CKD). This systematic review and meta-analysis aims to summarize findings from studies comparing dietary interventions with placebo/usual care/no treatment in the management of metabolic acidosis in outpatient adults with CKD.
Medline, Embase, Cochrane Central, CINAHL and Web of Science Core Collection were searched from inception to June 2022. Our primary outcome measure was change in serum bicarbonate. Any dietary intervention looking to manipulate dietary acid load was considered as an intervention. Data screening and extraction were performed by two independent reviewers. Random effects meta-analysis was performed to pool data.
Dietary interventions resulted in clinically significant improvement in serum bicarbonate [mean difference 2.98 (95% confidence interval 0.77, 5.19); I2: 91%] and higher estimated glomerular filtration rate (eGFR) levels [mean difference 3.16 (95% confidence interval 0.24, 6.08); I2: 67%] compared with controls. Serum potassium, albumin and body mass index remained unchanged. Dietary interventions were reported to be safe. Subgroup analyses indicated a superiority of plant-based over non-plant-based interventions in the improvement of acid-base balance and eGFR; however, these findings are from low-quality and heterogenous studies.
Our findings support the beneficial effects of dietary interventions aimed at reducing acid or adding base in the management of metabolic acidosis and kidney function in adults with CKD, with no adverse effects on serum potassium and nutritional status. Well-designed clinical trials looking at the treatment of metabolic acidosis with dietary interventions with a focus on adding base through fruit and vegetables are required.
代谢性酸中毒是肾脏疾病的常见并发症，可导致疾病进一步进展。碱疗法已用于治疗代谢性酸中毒数十年。然而，人们对其安全性和长期耐受性提出了一些担忧。现有数据表明，饮食干预对慢性肾脏病（CKD）的管理可能有益。本系统评价和荟萃分析旨在总结比较饮食干预与安慰剂/常规护理/不治疗在门诊成年CKD患者代谢性酸中毒管理中的研究结果。
检索了从创刊至2022年6月的Medline、Embase、Cochrane Central、CINAHL和Web of Science核心合集。我们的主要结局指标是血清碳酸氢盐的变化。任何旨在控制饮食酸负荷的饮食干预都被视为一种干预措施。由两名独立的评审员进行数据筛选和提取。采用随机效应荟萃分析来汇总数据。
与对照组相比，饮食干预使血清碳酸氢盐有临床显著改善[平均差异2.98（95%置信区间0.77，5.19）；I2：91%]，估计肾小球滤过率（eGFR）水平更高[平均差异3.16（95%置信区间0.24，6.08）；I2：67%]。血清钾、白蛋白和体重指数保持不变。据报道，饮食干预是安全的。亚组分析表明，在改善酸碱平衡和eGFR方面，基于植物的干预优于非基于植物的干预；然而，这些发现来自低质量和异质性研究。
我们的研究结果支持旨在减少酸或添加碱的饮食干预对成年CKD患者代谢性酸中毒和肾功能管理的有益作用，且对血清钾和营养状况无不良影响。需要开展精心设计的临床试验，研究通过饮食干预治疗代谢性酸中毒，重点是通过水果和蔬菜添加碱。
