Amiri Khosroshahi Reza, Zare Marzieh, Zeraattalab-Motlagh Sheida, Kiany Fatemeh, Talebi Sepide, Mohammadi Hamed
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran 1417613151, Iran.
Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran 1417613151, Iran.
Nutr Rev. 2025 Jul 1;83(7):e2127-e2138. doi: 10.1093/nutrit/nuae178.
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.
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.
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.
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.
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.
LPDs demonstrated beneficial effects on renal function in patients with CKD, which is supported by moderate to very low certainty evidence.
PROSPERO registration no. CRD42023473647.
慢性肾脏病（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），作为阻碍CKD进展的关键方法发挥着至关重要的作用。
本伞状综述的目的是深入了解LPD对CKD患者肾功能的影响，并评估现有证据的确定性。
通过PubMed、Scopus、Web of Science和Google Scholar等数据库对相关研究进行无限制检索，涵盖截至2023年6月的研究结果。
使用随机效应模型重新校准每个荟萃分析的效应量。采用推荐分级评估、制定和评价（GRADE）方法评估证据的确定性。
本研究纳入了25项荟萃分析，包括47项随机对照试验。中等确定性的证据表明，LPD可能降低糖化血红蛋白（HbA1c）和磷水平，以及CKD患者进展为终末期肾病的风险。此外，显著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，尽管证据的确定性较低。此外，LPD可大幅降低蛋白尿、尿尿素和甲状旁腺激素（PTH），尽管确定性非常低。对血清肌酐、钙、收缩压和舒张压的影响在统计学上无显著意义，证据的确定性从低到中等。
LPD对CKD患者的肾功能显示出有益作用，这得到了中等至非常低确定性证据的支持。
PROSPERO注册号CRD420234
