Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System-Inhibiting Treatment on Albuminuria
Meta-Analysis of the Effect of Dietary Sodium Restriction with or without Concomitant Renin-Angiotensin-Aldosterone System-Inhibiting Treatment on Albuminuria
复制标题
DOI：
10.2215/cjn.09110914
复制
发表时间：
2015-09-01
影响因子：
9.8
通讯作者：
Strazzullo, Pasquale
中科院分区：
文献类型：
--
作者：
D'Elia, Lanfranco;Rossi, Giovanni;Strazzullo, Pasquale
背景和目的尿白蛋白排泄量和/或白蛋白与肌酸酐比率与慢性肾脏病和心血管事件的高风险相关。几项研究调查了减少饮食钠摄入量对成人患者人群尿白蛋白排泄和/或白蛋白/肌酐比值的影响，但由于统计把握度不足，大多数研究不确定。对现有的随机对照试验进行荟萃分析可以克服这个问题，并得出更明确的结论。设计、设置、参与者和测量（从1996年到2014年10月）是随机进行的，将尿白蛋白排泄或白蛋白与肌酐比值表示为两种不同钠盐的作用之间的差异的对照试验摄入方案。对于每项研究，使用随机效应模型合并平均差异和95%置信区间。异质性，发表偏倚，亚组，和荟萃回归分析performed.Results 11研究符合预定义的纳入标准，并提供了23个队列，516名参与者和1-6周的随访时间。在汇总分析中，钠摄入量平均减少92 mmol/d与尿白蛋白排泄减少32.1%（95%置信区间，-44.3至-18.8）相关。在包括同时接受肾素-血管紧张素-醛固酮系统阻断治疗的患者的队列中，在干预持续至少2周的研究中，以及在有肾损伤证据的参与者中，限钠的效果更高。干预期间，尿白蛋白排泄的更大减少与血压的更大降低相关。白蛋白肌酐比值的变化分析提供了类似的result.Conclusions这一荟萃分析表明，钠的摄入量减少显着降低白蛋白排泄，更是在伴随的肾素-血管紧张素-醛固酮系统阻断治疗和肾损害的患者。
Background and objectives Urinary albumin excretion and/or albumin to creatinine ratio are associated with CKD and higher risk of cardiovascular events. Several studies investigated the effect of reduced dietary sodium intake on urinary albumin excretion and/or albumin to creatinine ratio in adult patient populations, but the majority was inconclusive because of insufficient statistical power. A meta-analysis of the randomized, controlled trials available could overcome this problem and lead to more definitive conclusions.Design, setting, participants, & measurements A systematic search of the online databases available (from 1996 to October of 2014) was conducted of randomized, controlled trials that expressed urinary albumin excretion or albumin to creatinine ratio as the difference between the effects of two different sodium intake regimens. For each study, the mean difference and 95% confidence intervals were pooled using a random effect model. Heterogeneity, publication bias, subgroup, and meta-regression analyses were performed.Results Eleven studies met the predefined inclusion criteria and provided 23 cohorts with 516 participants and 1-6 weeks of follow-up time. In the pooled analysis, an average reduction in sodium intake of 92 mmol/d was associated with a 32.1% (95% confidence interval, -44.3 to -18.8) reduction in urinary albumin excretion. The effect of sodium restriction was higher in the cohorts including patients on concomitant renin-angiotensin-aldosterone system-blocking therapy, in the studies with intervention lasting at least 2 weeks, and among participants with evidence of kidney damage. A greater reduction of urinary albumin excretion was associated with a higher decrease in BP during the intervention. The analysis of changes in albumin to creatinine ratio provided similar results.Conclusions This meta-analysis indicates that sodium intake reduction markedly reduces albumin excretion, more so during concomitant renin-angiotensin-aldosterone system-blocking therapy and among patients with kidney damage.