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. 2023 Aug;62(5):1957-1975.
doi: 10.1007/s00394-023-03143-7. Epub 2023 May 3.

Protein intake and risk of urolithiasis and kidney diseases: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society

Thomas Remer  1 , Nicole Kalotai  2 , Anna M Amini  2 , Andreas Lehmann  2 , Annemarie Schmidt  2 , Heike A Bischoff-Ferrari  3 , Sarah Egert  4 , Sabine Ellinger  5 , Anja Kroke  6 , Tilman Kühn  7   8   9   10 , Stefan Lorkowski  11   12 , Katharina Nimptsch  13 , Lukas Schwingshackl  14 , Armin Zittermann  15 , Bernhard Watzl  16 , Roswitha Siener  17 ; German Nutrition Society
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Protein intake and risk of urolithiasis and kidney diseases: an umbrella review of systematic reviews for the evidence-based guideline of the German Nutrition Society

Thomas Remer et al. Eur J Nutr. 2023 Aug.

Abstract

Purpose: Changes in dietary protein intake metabolically affect kidney functions. However, knowledge on potential adverse consequences of long-term higher protein intake (HPI) for kidney health is lacking. To summarise and evaluate the available evidence for a relation between HPI and kidney diseases, an umbrella review of systematic reviews (SR) was conducted.

Methods: PubMed, Embase and Cochrane Database of SRs published until 12/2022 were searched for the respective SRs with and without meta-analyses (MA) of randomised controlled trials or cohort studies. For assessments of methodological quality and of outcome-specific certainty of evidence, a modified version of AMSTAR 2 and the NutriGrade scoring tool were used, respectively. The overall certainty of evidence was assessed according to predefined criteria.

Results: Six SRs with MA and three SRs without MA on various kidney-related outcomes were identified. Outcomes were chronic kidney disease, kidney stones and kidney function-related parameters: albuminuria, glomerular filtration rate, serum urea, urinary pH and urinary calcium excretion. Overall certainty of evidence was graded as 'possible' for stone risk not to be associated with HPI and albuminuria not to be elevated through HPI (above recommendations (> 0.8 g/kg body weight/day)) and graded as 'probable' or 'possible' for most other kidney function-related parameters to be physiologically increased with HPI.

Conclusion: Changes of the assessed outcomes may have reflected mostly physiological (regulatory), but not pathometabolic responses to higher protein loads. For none of the outcomes, evidence was found that HPI does specifically trigger kidney stones or diseases. However, for potential recommendations long-term data, also over decades, are required.

Keywords: GFR; Kidney health; Protein guideline; Umbrella review; Urinary albumin excretion; Urolithiasis.

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Conflict of interest statement

A list of possible conflicts of interest is provided in Supplementary Material S9.

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Flow diagram on systematic reviews included
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