目的 系统评价慢性肾脏病(chronic kidney disease，CKD)患者的钾摄入量与死亡率及肾脏病进展的剂量-反应关系。 方法 计算机检索PubMed、The Cochrane Library、EMbase、Web of Science、CNKI、WanFang Data、VIP和CBM数据库，检索关于CKD患者钾摄入量与死亡率、肾脏病进展的研究，检索时限均从建库至2023年8月31日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后，采用R 4.2软件进行Meta分析，采用限制性立方样条函数和广义最小二乘估计方法进行剂量-反应Meta分析。 结果 共纳入14项队列研究，包括53 694例患者。线性Meta分析结果显示：钾摄入量与CKD患者死亡风险无显著相关(RR=0.875，95% CI：0.746～1.027，P=0.100)。剂量-反应分析结果显示：CKD患者钾摄入量与全因死亡率之间存在L型非线性关系(非线性检验P=0.010)；钾摄入量与CKD进展无明显的非线性趋势(非线性检验P=0.226)，线性趋势结果显示CKD患者钾摄入量每增加一个单位，CKD进展风险降低21.6%(RR=0.784，95% CI:0.625～0.983，P=0.031)。 结论 当前证据表明过低的钾摄入量不利于降低CKD患者的死亡与肾脏病进展的风险。受纳入研究数量和质量的限制，上述结论尚待更多高质量研究予以验证。
Objective To systematically review the dose-response relationship between dietary potassium intake and risk of mortality, CKD progression in chronic kidney disease patients. Methods PubMed, The Cochrane Library, EM-base, Web of Science, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect studies about dietary potassium intake and risk of mortality, CKD progression in patients with CKD from inception to August 2023. Two reviewers screened literature, extracted data and assessed the quality of included studies independently. Meta-analysis was performed by using R4.2, and the dose-response relationship was analyzed by using restricted cubic spline function and generalized least squares estimation. Results A total of 14 studies involving 53694 patients were included. The results of meta-analysis showed that no significant association between potassium intake and mortality in CKD patients (RR=0.875, 95% CI:0.746～1.027, P=0.100). Dose-response meta-analysis showed an L-shaped association between potassium intake and mortality in CKD patients (non-linear test P=0.010), while there was no significant non-linear trend between potassium intake and CKD progression (non-linear test P=0.226). The linear trend results showed that for every unit increase in potassium intake in CKD patients, the risk of CKD progression was reduced by 21.6% (RR=0.784,95% CI:0.625～0.983, P=0.031). Conclusion Current evidence suggests that potassium intake in CKD patients should not be excessively restricted. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.
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