PDF(Pubmed)
Abstract：
OBJECTIVE: Changes in dietary protein intake metabolically affect kidney functions. However, knowledge on potential adverse consequences of long-term higher protein intake (HPI) for kidney health is lacking. To summarise and evaluate the available evidence for a relation between HPI and kidney diseases, an umbrella review of systematic reviews (SR) was conducted.
METHODS: PubMed, Embase and Cochrane Database of SRs published until 12/2022 were searched for the respective SRs with and without meta-analyses (MA) of randomised controlled trials or cohort studies. For assessments of methodological quality and of outcome-specific certainty of evidence, a modified version of AMSTAR 2 and the NutriGrade scoring tool were used, respectively. The overall certainty of evidence was assessed according to predefined criteria.
RESULTS: Six SRs with MA and three SRs without MA on various kidney-related outcomes were identified. Outcomes were chronic kidney disease, kidney stones and kidney function-related parameters: albuminuria, glomerular filtration rate, serum urea, urinary pH and urinary calcium excretion. Overall certainty of evidence was graded as \'possible\' for stone risk not to be associated with HPI and albuminuria not to be elevated through HPI (above recommendations (> 0.8 g/kg body weight/day)) and graded as \'probable\' or \'possible\' for most other kidney function-related parameters to be physiologically increased with HPI.
CONCLUSIONS: Changes of the assessed outcomes may have reflected mostly physiological (regulatory), but not pathometabolic responses to higher protein loads. For none of the outcomes, evidence was found that HPI does specifically trigger kidney stones or diseases. However, for potential recommendations long-term data, also over decades, are required.
METHODS: PubMed, Embase and Cochrane Database of SRs published until 12/2022 were searched for the respective SRs with and without meta-analyses (MA) of randomised controlled trials or cohort studies. For assessments of methodological quality and of outcome-specific certainty of evidence, a modified version of AMSTAR 2 and the NutriGrade scoring tool were used, respectively. The overall certainty of evidence was assessed according to predefined criteria.
RESULTS: Six SRs with MA and three SRs without MA on various kidney-related outcomes were identified. Outcomes were chronic kidney disease, kidney stones and kidney function-related parameters: albuminuria, glomerular filtration rate, serum urea, urinary pH and urinary calcium excretion. Overall certainty of evidence was graded as \'possible\' for stone risk not to be associated with HPI and albuminuria not to be elevated through HPI (above recommendations (> 0.8 g/kg body weight/day)) and graded as \'probable\' or \'possible\' for most other kidney function-related parameters to be physiologically increased with HPI.
CONCLUSIONS: Changes of the assessed outcomes may have reflected mostly physiological (regulatory), but not pathometabolic responses to higher protein loads. For none of the outcomes, evidence was found that HPI does specifically trigger kidney stones or diseases. However, for potential recommendations long-term data, also over decades, are required.
摘要：
目的：饮食蛋白质摄入的变化会影响肾脏的代谢功能。然而,缺乏关于长期较高蛋白质摄入(HPI)对肾脏健康的潜在不利后果的知识.总结和评估HPI与肾脏疾病之间关系的现有证据，进行了系统评价(SR)的总括性综述.
方法：PubMed，搜索了截至2022年12月12日发布的Embase和CochraneSRs数据库，以查找有和没有随机对照试验或队列研究荟萃分析（MA）的相应SRs。为了评估方法学质量和结果特定的证据确定性，使用了AMSTAR2的修改版本和NutriGrade评分工具，分别。根据预定义的标准评估证据的总体确定性。
结果：确定了6个有MA的SR和3个无MA的SR对各种肾脏相关结局的影响。结果是慢性肾病，肾结石和肾功能相关参数：白蛋白尿，肾小球滤过率,血清尿素,尿pH和尿钙排泄。对于与HPI无关的结石风险和未通过HPI升高的白蛋白尿，证据的总体确定性被分级为“可能”，对于大多数其他肾功能相关参数，HPI在生理上增加，则被分级为“可能”或“可能”。
结论：评估结果的变化可能主要反映了生理（调节），但不是对更高蛋白质负荷的代谢反应。对于没有任何结果，有证据表明，HPI确实特异性引发肾结石或疾病。然而,对于潜在的长期数据建议，也是几十年来，是必需的。
方法：PubMed，搜索了截至2022年12月12日发布的Embase和CochraneSRs数据库，以查找有和没有随机对照试验或队列研究荟萃分析（MA）的相应SRs。为了评估方法学质量和结果特定的证据确定性，使用了AMSTAR2的修改版本和NutriGrade评分工具，分别。根据预定义的标准评估证据的总体确定性。
结果：确定了6个有MA的SR和3个无MA的SR对各种肾脏相关结局的影响。结果是慢性肾病，肾结石和肾功能相关参数：白蛋白尿，肾小球滤过率,血清尿素,尿pH和尿钙排泄。对于与HPI无关的结石风险和未通过HPI升高的白蛋白尿，证据的总体确定性被分级为“可能”，对于大多数其他肾功能相关参数，HPI在生理上增加，则被分级为“可能”或“可能”。
结论：评估结果的变化可能主要反映了生理（调节），但不是对更高蛋白质负荷的代谢反应。对于没有任何结果，有证据表明，HPI确实特异性引发肾结石或疾病。然而,对于潜在的长期数据建议，也是几十年来，是必需的。
