低盐饮食对慢性肾脏病结局的影响：系统评价和荟萃分析

Abstract

Objective The benefits of a low-salt diet for patients with chronic kidney disease (CKD) are controversial. We conducted a systematic review and meta-analysis of the effect of a low-salt diet on major clinical outcomes.

Design Systematic review and meta-analysis.

Data sources MEDLINE by Ovid, EMBASE and the Cochrane Library databases.

Eligibility criteria for selecting studies We included randomised controlled trials (RCTs) and cohort studies that assessed the effect of a low-salt diet on the renal composite outcomes (more than 50% decline in estimated glomerular filtration rate (eGFR) during follow-up, doubling of serum creatinine or end-stage renal disease), rate of eGFR decline, change in proteinuria, all-cause mortality events, cardiovascular (CV) events, and changes in systolic blood pressure and diastolic blood pressure.

Data extraction and synthesis Two independent researchers extracted data and evaluated their quality. Relative risks (RRs) with 95% CIs were used for dichotomous data. Differences in means (MDs) or standardised mean differences (SMDs) with 95% CIs were used to pool continuous data. We used the Cochrane Collaboration risk-of-bias tool to evaluate the quality of RCTs, and Newcastle–Ottawa Scale to evaluate the quality of cohort studies.

Results We found 9948 potential research records. After removing duplicates, we reviewed the titles and abstracts, and screened the full text of 230 publications. Thirty-three studies with 101 077 participants were included. A low-salt diet produced a 28% reduction in renal composite outcome events (RR: 0.72; 95% CI: 0.58 to 0.89). No significant effects were found in terms of changes in proteinuria (SMD: −0.71; 95% CI: −1.66 to 0.24), rate of eGFR (decline MD: 1.16; 95% CI: −2.02 to 4.33), risk of all-cause mortality (RR: 0.92; 95% CI: 0.58 to 1.46) and CV events (RR: 1.01; 95% CI: 0.46 to 2.22).

Conclusion A low-salt diet seems to reduce the risk for renal composite outcome events in patients with CKD. However, no compelling evidence indicated that such a diet would reduce the eGFR decline rate, proteinuria, incidence of all-cause mortality and CV events. Further, more definitive studies are needed.

PROSPERO registration number CRD42017072395.

摘要翻译（仅供参考）

目的 

低盐饮食对慢性肾脏病（CKD）患者的好处是有争议的。我们对低盐饮食对主要临床结果的影响进行了系统回顾和meta分析。

设计 

系统回顾和荟萃分析。

数据来源 

       Ovid的MEDLINE、EMBASE和Cochrane图书馆的数据库。

       选择研究的资格标准 我们包括随机对照试验（RCTs）和队列研究，评估低盐饮食对肾脏综合结果（随访期间估计肾小球滤过率（eGFR）下降超过50%，血清肌酐翻倍或终末期肾病）、eGFR下降率、蛋白尿变化、全因死亡事件、心血管（CV）事件以及收缩压和舒张压变化的影响。

       数据提取和综合 两位独立的研究人员提取了数据并评估了其质量。相对风险（RRs）与95%的CIs被用于二分法数据。均值差异（MDs）或标准化均值差异（SMDs）与95%CIs被用于汇集连续数据。我们使用Cochrane合作组织的偏见风险工具来评估RCTs的质量，使用Newcastle-Ottawa Scale来评估队列研究的质量。

结果 

       我们发现了9948条潜在的研究记录。在去除重复的记录后，我们审查了标题和摘要，并筛选了230份出版物的全文。纳入了33项研究，有101 077名参与者。低盐饮食可使肾脏综合结果事件减少28%（RR：0.72；95%CI：0.58至0.89）。在蛋白尿（SMD：-0.71；95%CI：-1.66至0.24）、eGFR（下降MD：1.16；95%CI：-2.02至4.33）、全因死亡风险（RR：0.92；95%CI：0.58至1.46）和CV事件（RR：1.01；95%CI：0.46至2.22）方面没有发现明显影响。

结论 

       低盐饮食似乎可以降低CKD患者的肾脏综合结果事件的风险。然而，没有令人信服的证据表明这种饮食会降低eGFR下降率、蛋白尿、全因死亡率和CV事件的发生率。此外，还需要更多明确的研究。