Diabetic Kidney Disease Benefits from Intensive Low-Protein Diet: Updated Systematic Review and Meta-analysis
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REVIEW
Diabetic Kidney Disease Benefits from Intensive LowProtein Diet: Updated Systematic Review and Metaanalysis Qiuling Li . Feng Wen . Yanhui Wang . Sheng Li . Shaochun Lin . Chunfang Qi . Zujiao Chen . Xueqian Qiu . Yifan Zhang . Shaogui Zhang . Yiming Tao . Zhonglin Feng . Zhilian Li . Ruizhao Li . Zhiming Ye . Xinling Liang . Shuangxin Liu . Jianteng Xie . Wenjian Wang
Received: September 1, 2020 / Accepted: October 19, 2020 Ó The Author(s) 2020
ABSTRACT A dietary protein intake (DPI) of between 0.6 and 0.8 g protein per kilogram body weight per day (g/kg/day) is frequently recommended for adults with moderate-to-advanced chronic kidney disease (CKD). However, evidence on whether patients with diabetic kidney disease (DKD) Qiuling Li, Feng Wen and Yanhui Wang contributed equally to this work.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13300020-00952-5) contains supplementary material, which is available to authorized users. Q. Li F. Wen Y. Wang S. Li S. Lin C. Qi Z. Chen X. Qiu Y. Zhang S. Zhang Y. Tao Z. Feng Z. Li R. Li Z. Ye X. Liang S. Liu J. Xie W. Wang (&) Division of Nephrology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China e-mail: [email protected] Q. Li S. Lin W. Wang Shantou University Medical College, Shantou 515041, China Y. Wang Z. Chen X. Qiu Y. Zhang S. Zhang W. Wang The Second School of Clinical Medicine, Southern Medical University, Guangzhou 510515, China S. Li C. Qi J. Xie W. Wang School of Medicine, South China University of Technology, Guangzhou 510006, China
actually benefit from a DPI of B 0.8 g/kg/day and from a low-protein diet (LPD) at CKD stages 1–3 has not been consistent. We systematically searched MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, as well as the bibliographies of articles identified in the search, for eligible randomized controlled trials that had investigated the effects of LPD (prescribed DPI \ 0.8 g/ kg/day) versus control diet on the progression of DKD. Nine trials that included 506 participants and follow-up periods varying from 4.5 to 60 months were included in the subsequent systematic review and meta-analysis. The data showed that patients with DKD who consumed \ 0.8 g protein/kg/day had a significantly reduced decline in glomerular filtration rate (GFR) (mean difference [MD] 22.31 mL/min/ 1.73 m2, 95% confidence interval [CI] 17.19, 27.42; P \ 0.01) and a significant decrease in proteinuria (standard mean difference [SMD] - 2.26 units, 95% CI - 2.99, - 1.52; P \ 0.001) versus those on the control diet. The benefits of LPD to patients with DKD at CKD stages 1–3 were a markedly decreased proteinuria (SMD - 0.96 units, 95% CI - 1.81, - 0.11; P = 0.03) and slight but significant decreases in glycated hemoglobin (- 0.42%) and cholesterol levels (- 0.22 mmol/L). Our meta-analysis indicated that a DPI of \ 0.8 g/kg/day was strongly associated with a slow decline in GFR and decreased proteinuria
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