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.

摘要翻譯（僅供參考）

目的 

低鹽飲食對(duì)慢性腎臟?。–KD）患者的好處是有爭(zhēng)議的。我們對(duì)低鹽飲食對(duì)主要臨床結(jié)果的影響進(jìn)行了系統(tǒng)回顧和meta分析。

設(shè)計(jì) 

系統(tǒng)回顧和薈萃分析。

數(shù)據(jù)來源 

       Ovid的MEDLINE、EMBASE和Cochrane圖書館的數(shù)據(jù)庫。

       選擇研究的資格標(biāo)準(zhǔn) 我們包括隨機(jī)對(duì)照試驗(yàn)（RCTs）和隊(duì)列研究，評(píng)估低鹽飲食對(duì)腎臟綜合結(jié)果（隨訪期間估計(jì)腎小球?yàn)V過率（eGFR）下降超過50%，血清肌酐翻倍或終末期腎?。GFR下降率、蛋白尿變化、全因死亡事件、心血管（CV）事件以及收縮壓和舒張壓變化的影響。

       數(shù)據(jù)提取和綜合 兩位獨(dú)立的研究人員提取了數(shù)據(jù)并評(píng)估了其質(zhì)量。相對(duì)風(fēng)險(xiǎn)（RRs）與95%的CIs被用于二分法數(shù)據(jù)。均值差異（MDs）或標(biāo)準(zhǔn)化均值差異（SMDs）與95%CIs被用于匯集連續(xù)數(shù)據(jù)。我們使用Cochrane合作組織的偏見風(fēng)險(xiǎn)工具來評(píng)估RCTs的質(zhì)量，使用Newcastle-Ottawa Scale來評(píng)估隊(duì)列研究的質(zhì)量。

結(jié)果 

       我們發(fā)現(xiàn)了9948條潛在的研究記錄。在去除重復(fù)的記錄后，我們審查了標(biāo)題和摘要，并篩選了230份出版物的全文。納入了33項(xiàng)研究，有101 077名參與者。低鹽飲食可使腎臟綜合結(jié)果事件減少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）、全因死亡風(fēng)險(xiǎn)（RR：0.92；95%CI：0.58至1.46）和CV事件（RR：1.01；95%CI：0.46至2.22）方面沒有發(fā)現(xiàn)明顯影響。

結(jié)論 

       低鹽飲食似乎可以降低CKD患者的腎臟綜合結(jié)果事件的風(fēng)險(xiǎn)。然而，沒有令人信服的證據(jù)表明這種飲食會(huì)降低eGFR下降率、蛋白尿、全因死亡率和CV事件的發(fā)生率。此外，還需要更多明確的研究。

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