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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 I2.

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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Acknowledgements

LC and PBD designed the research. LC and AM conducted the research. LC and AM analyzed the data. LC and PBD wrote the paper. LC, AM, JLS, DJAJ and PBD were responsible for critical revision of the manuscript. PBD had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to P B Darling.

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Competing interests

LC works as a casual Clinical Research Coordinator at GI Laboratories, Toronto, Canada. LC and AM have received research support from the Canadian Institutes of Health Research (CIHR). JLS has received research support from the CIHR, Calorie Control Council, The Coca-Cola Company (investigator initiated, unrestricted grant), Pulse Canada and The International Tree Nut Council Nutrition Research & Education Foundation. He has received travel funding, speaker fees and/or honoraria from the American Heart Association (AHA), American Society for Nutrition (ASN), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH), Canadian Diabetes Association (CDA), Canadian Nutrition Society (CNS), Calorie Control Council, Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), International Life Sciences Institute (ILSI) North America, International Life Sciences Institute (ILSI) Brazil, Abbott Laboratories, Pulse Canada, Dr. Pepper Snapple Group and The Coca-Cola Company. He is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of both the Canadian Diabetes Association (CDA) and European Association for the study of Diabetes (EASD), as well as being on the American Society for Nutrition (ASN) writing panel for a scientific statement on the metabolic and nutritional effects of fructose, sucrose and high-fructose corn syrup. He is an unpaid scientific advisor for the International Life Science Institute (ILSI) North America, Food, Nutrition and Safety Program (FNSP). His wife is an employee of Unilever Canada. DJAJ holds an unrestricted grant from the Coca-Cola Company and has served on the scientific advisory board for or received research support, consultant fees or honoraria from Barilla, Solae, Unilever, Hain Celestial, Loblaws Supermarkets, Sanitarium Company, Herbalife International, Pacific Health Laboratories Inc, Metagenics/MetaProteomics, Bayer Consumer Care, Oldways Preservation Trust, The International Tree Nut Council Nutrition Research & Education, The Peanut Institute, Procter and Gamble Technical Centre Limited, Griffin Hospital for the development of the NuVal System, Pepsi Company, Soy Advisory Board of Dean Foods, Alpro Soy Foundation, Nutritional Fundamentals for Health, Pacific Health Laboratories, Kellogg’s, Quaker Oats, The Coca-Cola Sugar Advisory Board, Agrifoods and Agriculture Canada (AAFC), Canadian Agriculture Policy Institute (CAPI), Abbott Laboratories, the Almond Board of California, the California Strawberry Commission, Orafti, the Canola and Flax Councils of Canada, Pulse Canada and the Saskatchewan Pulse Growers. DJAJ also holds additional grant support from the Canadian Institutes of Health Research, Canadian Foundation for Innovation, Ontario Research Fund and Advanced Foods and Material Network. DJAJ’s spouse is a vice president and director of research at GI Laboratories (Toronto, Ontario, Canada). PBD declares no conflict of interest.

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This study was presented in part at the Canadian Nutrition Society conference, St. John’s Newfoundland, 5–7 June 2014.

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Chiavaroli, L., Mirrahimi, A., Sievenpiper, J. et al. Dietary fiber effects in chronic kidney disease: a systematic review and meta-analysis of controlled feeding trials. Eur J Clin Nutr 69, 761–768 (2015). https://doi.org/10.1038/ejcn.2014.237

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