摘要目的:系统评价低蛋白饮食、低盐饮食、碱性饮食干预对慢性肾脏病（chronic kidney disease，CKD）患者发生复合肾脏终点事件、肾小球滤过率（estimated glomerular filtration rate，eGFR）每年变化速率及全因死亡率的影响。方法:检索Ovid门户网站提供的MEDLINE、Embase和Cochrane图书馆临床对照试验注册中心中关于低蛋白、低盐、碱性饮食对于CKD患者肾功能影响的随机对照研究。按纳入和排除标准筛选文献并评价文献质量。研究结局包括复合肾脏终点事件、肾小球滤过率每年的变化速率、全因死亡率。复合肾脏终点事件定义为随访期间eGFR水平较基线下降超过25%或50%、血清肌酐水平翻倍及终末期肾脏病。结果:最终纳入34项研究，共5 589例患者。Meta分析结果显示，低蛋白饮食、低盐饮食、碱性饮食干预可以降低发生复合肾脏终点事件的风险分别为（ RR=0.78，95% CI：0.64～0.96， P<0.001）、（ RR=0.64，95% CI：0.43～0.98， P<0.001）、（ RR=0.45，95% CI：0.28～0.73， P<0.01），并可显著延缓eGFR下降速率（ MD=1.85，95% CI：0.77～2.93， P=0.001）、（ MD=1.45，95% CI：0.53～2.37， P<0.001）、（ MD=1.84，95% CI：1.06～2.63， P<0.001），但对减少死亡风险没有临床意义（ RR=1.15，95% CI：0.76～1.73， P=0.167）、（ RR=0.96，95% CI：0.31～3.02， P=0.546）、（ RR=0.82，95% CI：0.48～1.40， P=0.057）。 结论:三种饮食干预均可能降低CKD人群肾功能下降的速度和发生复合肾脏终点事件的风险，但对全因死亡率没有产生明确的有益影响。

abstractsObjective:To systematically evaluate the effects of protein restriction, low-sodium diet and alkaline diet on renal outcomes, the rate of change in estimated glomerular filtration rate (eGFR) and all-cause mortality in chronic kidney disease (CKD) patients.Methods:Three main databases, Ovid, EMBASE and the Cochrane Library database, were searched for randomized controlled trials about the effects of protein restriction, alkaline diet, low-sodium diet in chronic kidney disease. The primary outcome was renal composite endpoint events, the annual rate of change in eGFR and all-cause mortality. Renal composite endpoint events was defined as >25% or 50% decrease from baseline in eGFR, doubling of serum creatinine, or the development of end-stage renal diseaseas during follow-up.The studies were selected according to inclusion and exclusion criteria and assessed for quality using Jadad Scale. Two investigators were chosen to search, extract and evaluate the data independently. Software Stata 16.0 and RevMan 5.4 were used for meta-analysis.Results:A total of 34 studies with 5 589 participants were included. Protein restriction ( RR = 0.78, 95% CI: 0.64 to 0.96, P < 0.001), alkaline diet ( RR = 0.64, 95% CI: 0.43 to 0.98, P < 0.001) and low-sodium diet ( RR = 0.45, 95% CI: 0.28 to 0.73, P < 0.01) reduced the risk of renal composite outcomes. Protein restriction ( MD = 1.85, 95% CI: 0.77 to 2.93, P = 0.001), alkaline diet ( MD = 1.45, 95% CI: 0.53 to 2.37, P < 0.001) and low-sodium diet ( MD = 1.84, 95% CI: 1.06 to 2.63, P < 0.001) also decreased the rate of delince in eGFR. But these dietary patterns did not show a clear beneficial effect for all-cause mortality ( RR = 1.15, 95% CI: 0.76 to 1.73, P = 0.167 for protein restriction, RR = 0.96, 95% CI: 0.31 to 3.02, P = 0.546 for alkaline diet and RR = 0.82, 95% CI: 0.48 to 1.40, P = 0.057 for low-sodium diet). Conclusion:The three dietary interventions may decline the rate of renal function exacerbation and decrease the risk of unfavourable renal outcomes in CKD patients, while have no clear beneficial effect on all-cause mortality.