BACKGROUNDDespite the growth in chronic kidney disease (CKD) epidemics, there remains no evidence-based lifestyle recommendations for primary prevention of CKD. Current primary prevention advice tends to extrapolate from recommendations of other non-communicable diseases (e.g. cardiovascular disease, hypertension), evidencing a need to summarise the evidence as it relates to CKD directly.OBJECTIVESTo evaluate the consistency of evidence associating lifestyle exposures (including diet, smoking and alcohol consumption) and the incidence of CKD in adults.METHODThis systematic review and meta-analysis systematically searched MEDLINE, Embase, CINAHL and references from eligible studies from database inception through June 2019. Eligible studies were prospective and retrospective cohort studies including adults without CKD, where a lifestyle exposure was reported. To be eligible, studies had to report on the association of a lifestyle factor (either diet, smoking and/or alcohol) to incident CKD (defined as a GFR <60mL/min). Data were extracted and validated by author-pairs, who also assessed risk of bias and evidence certainty. RESULTSA total of 45 studies encompassing 1,481,142 participants met the inclusion criteria for the review. Thirty-one studies involving 176,625 participants reported associations of 40 different dietary exposures (either foods or nutrients) to incident CKD. Meta-analysis showed that higher vegetable (OR 0.79 [95% CI: 0.70, 0.90]; I2=57%) and potassium (OR 0.78 [95% CI: 0.65, 0.94]; I2=48%) intake significantly decreased the odds of CKD; whereas higher salt intake (OR 1.21 [95% CI: 1.06, 1.38]; I2=59%) significantly increased the odds of CKD. Twelve studies involving 1,155,384 participants reported associations of smoking to incident CKD. Meta-analysis showed that both current smokers (OR 1.20 [95% CI: 1.12, 1.28, I2=80%, 12 studies] and former smokers (OR 1.09 [95% CI: 1.01, 1.17]; I2=90%, 6 studies) had significantly increased odds of CKD compared to never smokers; however, heterogeneity was high. Fourteen studies involving 104,167 participants reported associations of alcohol to incident CKD. Compared to lower intakes, meta-analysis showed higher intake of alcohol (RR 0.86 [95% CI: 0.79, 0.93]; I2=40%) was associated to significantly reduced risk of CKD. CONCLUSIONThis systematic review and meta-analysis identified various lifestyle factors that consistently associate with the incidence CKD in the community and may inform decisions for policy makers in the establishment of public health recommendations.
|Publication status||Submitted - 16 Mar 2021|
|Event||20th Congress of the International Society of Renal Nutrition and Metabolism - GuangZhou, China|
Duration: 16 Mar 2021 → 20 Mar 2021
|Conference||20th Congress of the International Society of Renal Nutrition and Metabolism|
|Period||16/03/21 → 20/03/21|