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Sugar- and artificially-sweetened beverages and the risks of chronic kidney disease: a systematic review and dose–response meta-analysis

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Abstract

Background

Consumption of sugar or artificially-sweetened beverages (SASBs) has been linked to albuminuria, decline in kidney function, and risk of chronic kidney disease (CKD). However, the results are controversial. We therefore aim to evaluate the effects of sugar or artificially-sweetened beverage consumption on CKD risk.

Methods

Original observational studies reporting relative risks (RRs) with 95% confidence intervals (CIs) for the association between sugar or artificially-sweetened beverage consumption and impaired renal function or CKD risk in adults were identified using a systematic search of PubMed and EMBASE from inception to 20 February, 2019. Random effects model was applied to derive summary RRs and 95% CIs. Linear and non-linear dose–response relationships were estimated using data from sugar or artificially-sweetened beverage consumption categories in each study.

Results

The summary RR of CKD for high versus low sugar-sweetened beverage consumption was 1.30 (95% CI 0.88–1.94) according to six included studies with a total of 25,455 participants, while the pooled RR of CKD for high versus low artificially sweetened beverage consumption was 1.40 (95% CI 0.65–3.02) according to three studies with a total of 19,995 participants. For dose–response analysis, a significant, increased risk of CKD was observed with the sugar or artificially-sweetened beverage consumption above seven servings per week (P < 0.001).

Conclusion

Our study found a positive association between consumption of sugar or artificially-sweetened beverage consumption and CKD, though it did not reach statistical significance. However, the dose–response results suggest that more than seven servings per week should be avoided.

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Funding

This work was supported by Shuang Ho Hospital (Grant number: W106HCP-01-2), Taipei Medical University (Grant number: TMU107-HHC-07 and TMU108-AE1-B58), and the Ministry of Science and Technology (Grant number: MOST109-2314-B-038-142-MY2).

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Author notes

  1. Jin-Shuen Chen and Mei-Yi Wu equally contributed.

Authors and Affiliations

  1. Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Wei-Cheng Lo

  2. Division of Nephrology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

    Shih-Hsiang Ou

  3. Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City, 235, Taiwan

    Chu-Lin Chou, Mei-Yi Wu & Mai-Szu Wu

  4. Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chu-Lin Chou, Mei-Yi Wu & Mai-Szu Wu

  5. Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Chu-Lin Chou

  6. Department of Education and Research, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan

    Jin-Shuen Chen

  7. TMU Research Center of Urology and Kidney, Taipei Medical University, Taipei, Taiwan

    Mei-Yi Wu & Mai-Szu Wu

  8. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

    Mei-Yi Wu

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Contributions

M-YW and J-SC had full access to all data in this study and took responsibility for the integrity of the data and the accuracy of the related analysis. Concept and design: W-CL and M-YW. literature search and data analysis and interpretation: W-CL, S-HO, and M-YW. Statistical analysis: W-CL and M-YW. Drafting of the manuscript: W-CL and S-HO. Critical revision of the manuscript on important intellectual content: all authors. Administrative, technical, and material support: W-CL, M-SW. Supervision: M-YW and M-SW.

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Correspondence to Mei-Yi Wu.

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Lo, WC., Ou, SH., Chou, CL. et al. Sugar- and artificially-sweetened beverages and the risks of chronic kidney disease: a systematic review and dose–response meta-analysis. J Nephrol 34, 1791–1804 (2021). https://doi.org/10.1007/s40620-020-00957-0

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