Exploring the application of Dietary Approaches to Stop Hypertension (DASH) in the management of patients with Chronic Kidney Disease: a systematic review and meta-analysis.

Background & Aim: Chronic Kidney Disease (CKD) remains a significant global non-communicable disease (NCD) that affects more than 10% of the world's population. Attention is gradually shifting to tertiary prevention of CKD to avoid End-Stage Renal Disease (ESRD) progression. This study reviewed evidence of the use of a Dietary Approach to Stop Hypertension (DASH) and its effect on disease progression among patients living with CKD.

Methods: A comprehensive search was conducted using the Scopus, PubMed, Web of Science, ProQuest, and EBSCOHost databases for studies published from 1997 to 2025. The PICO framework guided the search, focusing on patients with CKD, DASH as the intervention, other dietary and non-dietary approaches as comparisons, and CKD progression measured by changes in estimated Glomerular Filtration Rate (eGFR) and/or Urine Albumin-to-Creatinine Ratio (UACR) as outcomes. Effect sizes with 95% confidence intervals and pooled effects were calculated using random effects REML models and Z-tests. Percentage changes in renal function post-intervention, based on eGFR, were also computed. Cochran's Q test and the I-squared (I) statistic assessed study heterogeneity. This review protocol is registered with PROSPERO (CRD42024588682).

Results: Of the 174 studies screened, four met the eligibility criteria and were included in the review. All were prospective cohort studies with an average follow-up of 5.5 years and a combined patient sample size of 7033. Across studies, low DASH adherence was defined as scores in the lower half of the possible range used, and high adherence as scores in the upper half (e.g., 0-40 vs. 41-80; 0-4 vs. 5-9; 8-24 vs. 25-40). Low DASH adherence was associated with a mean eGFR improvement of 0.54 mL/min/1.73m (1.2%) (Z=0.57, p=0.57), while high adherence showed a greater improvement of 3.34 mL/min/1.73m (6.8%) (Z=1.77, p=0.08). Only one study assessed UACR, reporting a lower median UACR with high DASH adherence (33.6 mg/g) compared to low adherence (55.6 mg/g).

Conclusions: The DASH diet has the potential to slow CKD progression; however, consistent adherence is crucial to maximize its clinical benefits and improve renal outcomes. Although improvements in eGFR with DASH diet adherence are clinically meaningful, they lack statistical significance. These findings support global efforts towards achieving Sustainable Development Goal 3 for NCDs.