探讨饮食方法控制高血压（DASH）在慢性肾病患者管理中的应用：一项系统综述和荟萃分析

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-09-01 DOI:10.1016/j.clnesp.2025.08.030

Yaa Boahemaa Gyasi Aderoju , Frank Ekow Atta Hayford , Gloria Achempim-Ansong , Evans Duah , Tinyiko Violet Baloyi , Smangaliso Morerwa , Percival Agordoh , Gladys Dzansi

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引用次数: 0

摘要

背景与目的：慢性肾脏疾病（CKD）仍然是一种重要的全球非传染性疾病（NCD），影响着世界10%以上的人口。人们的注意力逐渐转向CKD的三级预防，以避免终末期肾脏疾病（ESRD）的进展。本研究回顾了在CKD患者中使用饮食方法来停止高血压（DASH）及其对疾病进展的影响的证据。方法：利用Scopus、PubMed、Web of Science、ProQuest和EBSCOHost数据库对1997 - 2025年发表的研究进行综合检索。PICO框架指导了研究，重点关注CKD患者，DASH作为干预，其他饮食和非饮食方法作为比较，CKD进展通过肾小球滤过率（eGFR）和/或尿白蛋白与肌酐比（UACR）的变化来衡量。采用随机效应REML模型和z检验计算95%置信区间的效应量和合并效应。基于eGFR，还计算了干预后肾功能的百分比变化。Cochran's Q检验和i平方（I2）统计量评估了研究的异质性。本审查方案已在PROSPERO注册（CRD42024588682）。结果：在筛选的174项研究中，有4项符合入选标准，纳入本综述。所有研究均为前瞻性队列研究，平均随访5.5年，合并患者样本量为7033例。在所有研究中，低DASH依从性被定义为得分在可能范围的下半部分，高依从性被定义为得分在上半部分（例如，0-40 vs. 41-80; 0-4 vs. 5-9; 8-24 vs. 25-40）。低DASH依从性与平均eGFR改善相关，为0.54 mL/min/1.73m2 (1.2%) (Z=0.57, p=0.57)，而高依从性与平均eGFR改善相关，为3.34 mL/min/1.73m2 (6.8%) （Z=1.77, p=0.08）。只有一项研究评估了UACR，报告了高DASH依从性（33.6 mg/g）比低依从性（55.6 mg/g）更低的中位UACR。结论：DASH饮食具有减缓CKD进展的潜力；然而，持续的依从性对于最大化其临床益处和改善肾脏预后至关重要。尽管坚持DASH饮食对eGFR的改善具有临床意义，但缺乏统计学意义。这些发现支持全球为实现非传染性疾病可持续发展目标3所做的努力。

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Exploring the application of Dietary Approaches to Stop Hypertension (DASH) in the management of patients with Chronic Kidney Disease: A systematic review and meta-analysis

Background & aim

Chronic Kidney Disease (CKD) remains a significant global non-communicable disease (NCD) that affects more than 10 % of the world's population. Attention is gradually shifting to tertiary prevention of CKD to avoid End-Stage Renal Disease (ESRD) progression. This study reviewed evidence of the use of a Dietary Approach to Stop Hypertension (DASH) and its effect on disease progression among patients living with CKD.

Methods

A comprehensive search was conducted using the Scopus, PubMed, Web of Science, ProQuest, and EBSCOHost databases for studies published from 1997 to 2025. The PICO framework guided the search, focusing on patients with CKD, DASH as the intervention, other dietary and non-dietary approaches as comparisons, and CKD progression measured by changes in estimated Glomerular Filtration Rate (eGFR) and/or Urine Albumin-to-Creatinine Ratio (UACR) as outcomes. Effect sizes with 95 % confidence intervals and pooled effects were calculated using random effects REML models and Z-tests. Percentage changes in renal function post-intervention, based on eGFR, were also computed. Cochran's Q test and the I-squared (I²) statistic assessed study heterogeneity. This review protocol is registered with PROSPERO (CRD42024588682).

Results

Of the 174 studies screened, four met the eligibility criteria and were included in the review. All were prospective cohort studies with an average follow-up of 5.5 years and a combined patient sample size of 7033. Across studies, low DASH adherence was defined as scores in the lower half of the possible range used, and high adherence as scores in the upper half (e.g., 0–40 vs. 41–80; 0–4 vs. 5–9; 8–24 vs. 25–40). Low DASH adherence was associated with a mean eGFR improvement of 0.54 ml/min/1.73 m² (1.2 %) (Z = 0.57, p = 0.57), while high adherence showed a greater improvement of 3.34 ml/min/1.73 m² (6.8 %) (Z = 1.77, p = 0.08). Only one study assessed UACR, reporting a lower median UACR with high DASH adherence (33.6 mg/g) compared to low adherence (55.6 mg/g).

Conclusions

The DASH diet has the potential to slow CKD progression; however, consistent adherence is crucial to maximize its clinical benefits and improve renal outcomes. Although improvements in eGFR with DASH diet adherence are clinically meaningful, they lack statistical significance. These findings support global efforts towards achieving Sustainable Development Goal 3 for NCDs.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.