Effect Of Diet Protein Restriction On Progression Of Chronic Kidney Disease,a Systematic Review And Meta-analysis

Background:Dietary protein restriction has long been thought to play an important role in the progression of chronic kidney disease(CKD),but what effect dietary protein has on the rate of decline in kidney function remain controversial.Objective:We undertook a systematic review and meta-analysis of randomized controlled trials(RCTs)to assess the influence of protein restriction on chronic kidney disease.Method:Ovid MEDLINE,EMBASE,and the Cochrane Library were searched to identify RCTs compared different levels of protein intake for at least 24 weeks in adult patients with CKD.The outcomes included kidney failure events,the rate of change in estimated glomerular filtration rate(eGFR)per year,all cause death events,Change of proteinuria,serum phosphorus concentration,serum albumin and body mass index(BMI).Results:19 trails with 2492 subjects were analyzed.Low protein diet reduced the risk of kidney failure and end-stage renal disease(ESRD)(OR: 0.59,OR = 0.64)but did not produce a clear beneficial effect for all cause death events.The change in mean difference for rate of decline in eGFR was significant(MD: 1.85,P = 0.001),and for proteiniria(MD:-0.44,P = 0.02).Low protein diet also reduced serum phosphorus concentration and theresult did not suggest malnutrition caused by protein restriction.Conclusions:Low protein diet reduces the rate of decline in renal function and the risk of kidney failure for CKD population,especially for non-diabetic nephropathy.And it is safe for nutritional status.