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Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials.

Abstract

BACKGROUND/OBJECTIVES

Chronic kidney disease (CKD) is a major health concern associated with increased risk of cardiovascular disease, morbidity and mortality. Current CKD practice guidelines overlook dietary fiber, which is chronically low in the renal diet. However, increasing dietary fiber has been proposed to ameliorate the progress of CKD. We therefore conducted a systematic review and meta-analysis on the effect of dietary fiber intake on serum urea and creatinine as classical markers of renal health in individuals with CKD.

SUBJECTS/METHODS

We searched MEDLINE, EMBASE, CINHAL and the Cochrane Library for relevant clinical trials with a follow-up ⩾7 days. Data were pooled by the generic inverse variance method using random-effects models and expressed as mean difference (MD) with 95% confidence intervals (95% CIs). Heterogeneity was assessed by the Cochran Q statistic and quantified by I(2).

RESULTS

A total of 14 trials involving 143 participants met the eligibility criteria. Dietary fiber supplementation significantly reduced serum urea and creatinine levels in the primary pooled analyses (MD, -1.76 mmol/l (95% CI, -3.00, -0.51), P<0.01 and MD, -22.83 mmol/l (95% CI, -42.63, -3.02), P=0.02, respectively) with significant evidence of interstudy heterogeneity only in the analysis of serum urea.

CONCLUSIONS

This is the first study to summarize the potential beneficial effects of dietary fiber in the CKD population demonstrating a reduction in serum urea and creatinine, as well as highlighting the lack of clinical trials on harder end points. Larger, longer, higher-quality clinical trials measuring a greater variety of uremic toxins in CKD are required (NCT01844882).

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  • Authors+Show Affiliations

    ,

    1] Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada.

    ,

    1] Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada [2] School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

    ,

    1] Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada [3] Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada [4] Division of Endocrinology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.

    ,

    1] Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada [3] Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada [4] Division of Endocrinology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.

    1] Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada [2] Clinical Nutrition and Risk Factor Modification Centre, St. Michael's Hospital, Toronto, Ontario, Canada [3] Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.

    Source

    MeSH

    Biomarkers
    Combined Modality Therapy
    Controlled Clinical Trials as Topic
    Creatinine
    Cross-Over Studies
    Dietary Fiber
    Dietary Supplements
    Disease Progression
    Fermentation
    Gastrointestinal Microbiome
    Humans
    Practice Guidelines as Topic
    Renal Dialysis
    Renal Insufficiency, Chronic
    Urea

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review

    Language

    eng

    PubMed ID

    25387901

    Citation

    TY - JOUR T1 - Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials. AU - Chiavaroli,L, AU - Mirrahimi,A, AU - Sievenpiper,J L, AU - Jenkins,D J A, AU - Darling,P B, Y1 - 2014/11/12/ PY - 2014/6/25/received PY - 2014/9/11/revised PY - 2014/9/21/accepted PY - 2014/11/12/aheadofprint PY - 2014/11/13/entrez PY - 2014/11/13/pubmed PY - 2016/3/31/medline SP - 761 EP - 8 JF - European journal of clinical nutrition JO - Eur J Clin Nutr VL - 69 IS - 7 N2 - BACKGROUND/OBJECTIVES: Chronic kidney disease (CKD) is a major health concern associated with increased risk of cardiovascular disease, morbidity and mortality. Current CKD practice guidelines overlook dietary fiber, which is chronically low in the renal diet. However, increasing dietary fiber has been proposed to ameliorate the progress of CKD. We therefore conducted a systematic review and meta-analysis on the effect of dietary fiber intake on serum urea and creatinine as classical markers of renal health in individuals with CKD. SUBJECTS/METHODS: We searched MEDLINE, EMBASE, CINHAL and the Cochrane Library for relevant clinical trials with a follow-up ⩾7 days. Data were pooled by the generic inverse variance method using random-effects models and expressed as mean difference (MD) with 95% confidence intervals (95% CIs). Heterogeneity was assessed by the Cochran Q statistic and quantified by I(2). RESULTS: A total of 14 trials involving 143 participants met the eligibility criteria. Dietary fiber supplementation significantly reduced serum urea and creatinine levels in the primary pooled analyses (MD, -1.76 mmol/l (95% CI, -3.00, -0.51), P<0.01 and MD, -22.83 mmol/l (95% CI, -42.63, -3.02), P=0.02, respectively) with significant evidence of interstudy heterogeneity only in the analysis of serum urea. CONCLUSIONS: This is the first study to summarize the potential beneficial effects of dietary fiber in the CKD population demonstrating a reduction in serum urea and creatinine, as well as highlighting the lack of clinical trials on harder end points. Larger, longer, higher-quality clinical trials measuring a greater variety of uremic toxins in CKD are required (NCT01844882). SN - 1476-5640 UR - https://www.unboundmedicine.com/medline/citation/25387901/full_citation L2 - http://dx.doi.org/10.1038/ejcn.2014.237 ER -