Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis

Michaela C Devries, Arjun Sithamparapillai, K Scott Brimble, Laura Banfield, Robert W Morton, Stuart M Phillips, Michaela C Devries, Arjun Sithamparapillai, K Scott Brimble, Laura Banfield, Robert W Morton, Stuart M Phillips

Abstract

Background: Higher-protein (HP) diets are advocated for several reasons, including mitigation of sarcopenia, but their effects on kidney function are unclear.

Objective: This meta-analysis was conducted to determine the effect of HP intakes on kidney function in healthy adults.

Methods: We conducted a systematic review and meta-analysis of trials comparing HP (≥1.5 g/kg body weight or ≥20% energy intake or ≥100 g protein/d) with normal- or lower-protein (NLP; ≥5% less energy intake from protein/d compared with HP group) intakes on kidney function. Medline and EMBASE databases were searched. Randomized controlled trials comparing the effects of HP with NLP (>4 d duration) intakes on glomerular filtration rate (GFR) in adults without kidney disease were included.

Results: A total of 2144 abstracts were reviewed, with 40 articles selected for full-text review; 28 of these were analyzed and included data from 1358 participants. Data were analyzed using random-effects meta-analysis (RevMan 5; The Cochrane Collaboration), meta-regression (STATA; StataCorp), and dose-response analysis (Prism; GraphPad). Analyses were conducted using postintervention (post) GFR and the change in GFR from preintervention to post. The post-only comparison showed a trivial effect for GFR to be higher after HP intakes [standardized mean difference (SMD): 0.19; 95% CI: 0.07, 0.31; P = 0.002]. The change in GFR did not differ between interventions (SMD: 0.11; 95% CI: -0.05, 0.27; P = 0.16). There was a linear relation between protein intake and GFR in the post-only comparison (r = 0.332, P = 0.03), but not between protein intake and the change in GFR (r = 0.184, P = 0.33). The main limitation of the current analysis is the unclear risk of selection bias of the included trials.

Conclusions: Postintervention GFR comparisons indicate that HP diets result in higher GFRs; however, when changes in GFR were compared, dietary protein had no effect. Our analysis indicates that HP intakes do not adversely influence kidney function on GFR in healthy adults.

Figures

FIGURE 1
FIGURE 1
PRISMA flow diagram showing flow of studies through the systematic review process. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
FIGURE 2
FIGURE 2
Forest plot of a random-effects meta-analysis on renal function after HP compared with NLP intake in healthy people. Values are standardized mean differences (95% CIs). The shaded circles represent the point estimate for each individual trial, and the horizontal line extending from each circle represents the upper and lower limits of the 95% CI. The size of the shaded circle indicates the relative weight of the trial in the meta-analysis. The diamonds represent the overall standardized mean difference of the trials. GFR, glomerular filtration rate; HP, high-protein; IV, inverse variance; NLP, normal- or low-protein; Std., standardized.
FIGURE 3
FIGURE 3
Forest plot of a random-effects meta-analysis on the change in renal function induced by HP compared with NLP intake in healthy people. Values are standardized mean differences (95% CIs). The shaded circles represent the point estimate for each individual trial, and the horizontal line extending from each circle represents the upper and lower limits of the 95% CI. The size of the shaded circle indicates the relative weight of the trial in the meta-analysis. The diamonds represent the overall standardized mean difference of the trials. HP, high-protein; IV, inverse variance; NLP, normal- or low-protein; PG, parallel-group; Std., standardized: X-over, crossover.
FIGURE 4
FIGURE 4
Linear regression analysis showing the dose-response effect between increasing protein intake and post eGFR (r = 0.332, P = 0.03) (A) and the change in GFR in response to the intervention (r = 0.184, P = 0.33) (B) in healthy people. GFR and ΔGFR were reported as mL/min or as mL · (min · 1.73 m2)−1 depending on whether studies used clearance or eGFR measurements. BW, body weight; eGFR, estimated glomerular filtration rate; GFR, glomerular filtration rate.

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