Altered dietary salt intake for preventing diabetic kidney disease and its progression

Hodson, Elisabeth M; Cooper, Tess E

doi:10.1002/14651858.cd006763.pub3

Cited by 7 publications

(9 citation statements)

References 75 publications

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“…A total of 3 meta-analyses ( 10 , 13 , 30 ) studied the effect of a salt restriction diet on DN incidence. The meta-analysis of Hodson et al.…”

Section: Major Outcomesmentioning

confidence: 99%

“…The meta-analysis of Hodson et al. published in 2023 ( 13 ) included 12 RCTs describing 400 patients with DN. An umbrella review revealed that, compared with a usual or high-salt diet, a salt restriction diet significantly improved SBP (MD -7.36, 95% CI -10.75 to -3.98) (very low-quality evidence), DBP (MD -3.17, 95% CI -4.58 to -1.76) (very low-quality evidence), CrCl (MD -6.05, 95% CI -10.00 to -2.10) (low-quality evidence), and body weight (MD -1.21, 95% CI -1.73 to -0.68) (very low-quality evidence) in DN patients.…”

Section: Major Outcomesmentioning

confidence: 99%

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Effects of dietary intervention on diabetic nephropathy: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials

Cai,

Huang,

et al. 2024

Front. Endocrinol.

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ObjectiveTo evaluate the quality of evidence, potential biases, and validity of all available studies on dietary intervention and diabetic nephropathy (DN).MethodsWe conducted an umbrella review of existing meta-analyses of randomized controlled trials (RCTs) that focused on the effects of dietary intervention on DN incidence. The literature was searched via PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. According to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE), evidence of each outcome was evaluated and graded as “high”, “moderate”, “low” or “very low” quality to draw conclusions. Additionally, we classified evidence of outcomes into 4 categories.ResultsWe identified 36 meta-analyses of RCTs and 55 clinical outcomes of DN from 395 unique articles. Moderate-quality evidence suggested that probiotic supplementation could significantly improve blood urea nitrogen (BUN), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in DN patients. Low-quality evidence indicated that probiotic supplementation significantly improved the serum creatinine concentration, urinary albumin–creatinine ratio (UACR), fasting blood glucose (FBG), HbA1c and high-density lipoprotein cholesterol (HDL-C) in DN patients. In addition, low-quality evidence suggested that a salt restriction diet could significantly improve the creatinine clearance rate (CrCl) in patients with DN. Low-quality evidence suggested that vitamin D supplementation could significantly improve the UACR in patients with DN. In addition, low-quality evidence has indicated that soy isoflavone supplementation could significantly improve BUN, FBG, total cholesterol (TC), triglyceride (TG) and LDL-C levels in patients with DN. Furthermore, low-quality evidence suggested that coenzyme Q10 supplementation could significantly improve HbA1c, TC and HDL-C in patients with DN, and dietary polyphenols also significantly improved HbA1c in patients with DN. Finally, low-quality evidence suggested that supplementation with antioxidant vitamins could significantly improve the serum creatinine concentration, systolic blood pressure, and HbA1c level in patients with DN. Given the small sample size, all significantly associated outcomes were evaluated as class IV evidence.ConclusionModerate to low amounts of evidence suggest that supplementation with probiotics, vitamin D, soy isoflavones, coenzyme Q10, dietary polyphenols, antioxidant vitamins, or salt-restricted diets may significantly improve clinical outcomes in patients with DN.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024512670.

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“…A total of 3 meta-analyses ( 10 , 13 , 30 ) studied the effect of a salt restriction diet on DN incidence. The meta-analysis of Hodson et al.…”

Section: Major Outcomesmentioning

confidence: 99%

Section: Major Outcomesmentioning

confidence: 99%

Effects of dietary intervention on diabetic nephropathy: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials

Cai,

Huang,

et al. 2024

Front. Endocrinol.

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“…In another systematic review, of 13 trials in type 1 and type 2 diabetic patients, SBP and DBP showed a significant reduction with short periods of salt restriction similar to that obtained with single drug therapy for hypertension in subjects with diabetes and normal GFR. The salt intake in the two treatment arms differed by at least 34 mmol/day [26]. The two systematic reviews suggested that compared with high-salt diet, low-salt diet (with a mean difference in sodium intake of 80 mEq/day) significantly reduces SBP of 4.9 mmHg and proteinuria of 0.39 g/ day and albuminuria of 0.05 g/day [27].…”

Section: Salt-restricted Dietmentioning

confidence: 99%

Physical activity and nutrition in chronic kidney disease

Wang

March

Burton

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewLifestyle intervention is considered a cornerstone in chronic kidney disease management and has been recommended in different international or regional clinical practice guidelines in chronic kidney disease. However, evidence was largely based on the general population. Here we summarized the latest evidence supporting lifestyle intervention in chronic kidney disease.Recent findingsBoth observational cohort studies as well as randomized controlled trials have demonstrated health benefits with more physical activity in chronic kidney disease. There are compelling observational data supporting different health and kidney benefits with a healthy dietary pattern rich in fruits and vegetables, whole grains, plant-based foods and low in salt, low in sugar, saturated fat, red meat and ultraprocessed foods, a plant-based diet or Mediterranean diet in chronic kidney disease population. Clinical and epidemiologic studies also showed that higher 24 h urine potassium excretion (as proxy of higher dietary potassium intake) may be associated with lower blood pressure, better kidney outcomes and lower mortality in chronic kidney disease population. Randomized controlled trials also suggested that salt substitutes improved blood pressure control, reduced all-cause death and cardiovascular event risk in the general population compared with regular salt.SummaryAccumulating evidence supports the current recommendation of encouraging physical activity and promoting a healthy dietary pattern in chronic kidney disease patients. Whether potassium needs restriction in chronic kidney disease diet requires further review. The safety versus benefits of salt substitutes in patients with moderate and advanced chronic kidney disease warrants further investigation.

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“…10 Regarding the dietary treatment of renal impairment in patients with diabetes, especially in the advanced stages of kidney disease, low-protein and sodium-restricted diets are thought to protect kidney function. [11][12][13] However, considering that there are often antagonistic or synergistic effects between some nutrients, a recommended dietary pattern consisting of a complex variety of foods may be more comprehensive and meaningful than single-food or nutrient recommendations. For example, a study in Taiwan suggests that a diet characterised by a high intake of fish and vegetables may be related to better renal function indicators in participants with type 2 diabetes.…”

Section: Introductionmentioning

confidence: 99%

“…Dietary interventions for DKD may also effectively improve kidney function and prevent other organ complications 10 . Regarding the dietary treatment of renal impairment in patients with diabetes, especially in the advanced stages of kidney disease, low‐protein and sodium‐restricted diets are thought to protect kidney function 11–13 . However, considering that there are often antagonistic or synergistic effects between some nutrients, a recommended dietary pattern consisting of a complex variety of foods may be more comprehensive and meaningful than single‐food or nutrient recommendations.…”

Section: Introductionmentioning

confidence: 99%

Associations between dietary patterns and renal impairment in individuals with diabetes: a cross‐sectional study

Ding,

Wu,

Liu

et al. 2023

J Human Nutrition Diet

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BackgroundA variety of chronic diseases are affected by diet. To our knowledge, few studies have investigated the relationship between dietary patterns and renal impairment in individuals with diabetes within an Asian population. This study aimed to assess the relationship between renal impairment and dietary patterns in individuals with diabetes within a Chinese population.MethodsIn this cross‐sectional survey, we analysed data on 1522 participants with diabetes aged 18 years or older who took part in the China National Diabetic Chronic Complications Study. We utilised the Chinese Diabetes Complications Questionnaire, including the semiquantitative food frequency questionnaire (SQFFQ). We identified three dietary patterns using factor analysis: Chinese traditional, healthy and plant‐based dietary patterns, and these dietary patterns were used to classify participants into four groups based on the quartiles of their scores. A decrease in the estimated glomerular filtration rate (eGFR; <60 mL/min/1.73 m2) and an increase in the albumin‐to‐creatinine ratio (ACR; ≥3 mg/mmol) were used as indicators of renal impairment. Binary logistic regression models were used to estimate the odds ratio (OR) of the highest quartile (Q4: high intake levels of each dietary pattern) for renal impairment compared to the lowest quartile (Q1: low intake levels of each dietary pattern).ResultsAmong the 1522 participants, there was a 5.5% prevalence of low eGFR, with prevalence rates of 5.2% in men and 5.9% in women, yet the prevalence of albuminuria was as high as 47.9%. After adjusting for confounders, participants in Q4 of the plant‐based dietary pattern had a smaller OR for renal impairment than those in Q1.ConclusionsOur findings demonstrated that a plant‐based dietary pattern is associated with a reduced risk of renal impairment in a population with diabetes.

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Altered dietary salt intake for preventing diabetic kidney disease and its progression

Cited by 7 publications

References 75 publications

Effects of dietary intervention on diabetic nephropathy: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials

Effects of dietary intervention on diabetic nephropathy: an umbrella review of systematic reviews and meta-analyses of randomized controlled trials

Physical activity and nutrition in chronic kidney disease

Associations between dietary patterns and renal impairment in individuals with diabetes: a cross‐sectional study

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