Dietary Approaches to Stop Hypertension and Risk of Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Observational Studies

Clin Nutr. 2020 Jul;39(7):2035-2044. doi: 10.1016/j.clnu.2019.10.004. Epub 2019 Oct 15.

Abstract

Background & aims: Dietary Approaches to Stop Hypertension (DASH) diet has been favorably linked to important risk factors associated with development of chronic kidney disease (CKD), such as insulin resistance, hypertension, and dyslipidemia. However, the protective role of DASH dietary patterns in development of CKD, as measured by estimated glomerular filtration rate (eGFR), remains inconsistent in the literature. The aim of the current systematic review was to summarize the findings of previous observational studies and quantify the potential association between DASH dietary patterns and the risk of CKD using meta-analysis.

Methods: A comprehensive search was done with the use of MEDLINE, EMBASE, Web of Sciences, and Scopus databases to find relevant articles published prior to June 2019. Search terms included: ([Dietary Approaches to Stop Hypertension] OR [DASH]) AND ([Kidney Failure, Chronic] OR [Renal Insufficiency, Chronic] OR [Chronic Kidney Disease], OR [CKD] OR [End-Stage Renal Disease] OR [ESRD] OR [Kidney] OR [Renal]). To pool the risk estimates, fixed-effects and random-effects models were applied. Cochrane Q test was performed to detect sources of heterogeneity among the included studies.

Results: Out of the seven studies included in the systematic review, six were eligible for inclusion in the meta-analysis. The total sample size was 568,213 participants including 16,694 cases of CKD. Combined risk estimates for 2 cross-sectional and 4 prospective cohort studies showed an inverse association between DASH dietary patterns and risk of CKD (Pooled risk estimate: 0.77, 95% CI 0.63-0.94; p = 0.01). Stratified analysis showed a marginally significant relationship between DASH dietary patterns and risk of CKD in prospective cohort studies (Pooled risk estimate: 0.79, 95% CI 0.61-1.01; p = 0.05), and no significant association in cross-sectional studies (Pooled risk estimate: 0.71, 95% CI 0.38-1.34; p = 0.29), respectively. A significant association was observed between DASH dietary patterns and risk of CKD in the studies extracted DASH based on nutrients (Pooled risk estimate: 0.78, 95% CI 0.63-0.97; p = 0.02), compared to the studies extracted DASH based on food groups (Pooled risk estimate: 0.66, 95% CI 0.28-1.58; p = 0.35).

Conclusions: The results of the present study showed a significant inverse association between DASH dietary patterns and the risk of developing CKD. Adherence to DASH dietary patterns might have protective effects against CKD development and progression. Further research is required to confirm the certainty of estimates.

Keywords: Chronic kidney disease; Dietary approach to stop hypertension; Kidney dysfunction; Meta-analysis.