Effect Of Alkaline Diet In Patients With CKD:A Meta-Analysis

Objective:Metabolic acidosis accelerates the progression of Chronic Kidney Disease(CKD)and increases the mortality in patients with CKD,while the effect of alkaline diet on progression of renal function and all-cause mortality in patients with CKD is still controversial.Therefore,we undertook a systematic review to investigate the effect of alkaline diet on progression of renal function and related prognosis in adult patients with CKD.Methods:We searched the Ovid MEDLINE,Embase,and Cochrane Library databases according to the predefined plan until May 2018.All randomized controlled trials and cohort studies evaluating the effects of alkaline diet on renal outcomes(including renal failure events,rapid progression of CKD,annual change rate of estimated glomerular filtration rate(eGFR)and changes of urine protein.Renal failure is defined as>25%or50%decrease in eGFR from the baseline values,doubling of serum creatinine,or end-stage renal diseaseas during follow-up.Rapid progression of CKD is defined as a>3mL/min/1.73m~2decrease in eGFR within one year),all-cause mortality,serum albumin and serum bicarbonate in CKD patients were include.Study selection,data extraction,and quality assessment were performed by two independent researchers.The random effect model was used to analyze the data.Results:A total of 17 studies including 2712 patients with CKD were analyzed.Compared with the control group,alkaline diet treatment could produce a 58%relative risk(RR)reduction for kidney failure events(95%confidence interval(95%CI):0.25,0.70),a 66%RR reduction for rapid progression of CKD events(95%CI:0.19,0.60),slow down the decline in the eGFR 2.01mL/min/1.73m~2/year(95%CI:1.19,2.84),and produce a 40%RR reduction for all-cause mortality events(95%CI:0.36,0.99).It is noticeable that reduction of all-cause mortality may better in patients with CKD3-4 than in patients with continuous ambulatory peritoneal dialysis and renal transplantation.There were no significant effect on decrease in urinary protein,increase in level of serum albumin and serum bicarbonate.Conclusion:As a economical and safe treatment,alkaline diet may improve the renal outcome(kidney failure,rapid progression of CKD and decrease in eGFR)and reduce the risk for all-cause mortality.