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Review
. 2024 Apr 27;12(2):e004101.
doi: 10.1136/bmjdrc-2024-004101.

The case for a ketogenic diet in the management of kidney disease

Shaminie J Athinarayanan  1 , Caroline G P Roberts  2 , Chandan Vangala  3 , Greeshma K Shetty  2 , Amy L McKenzie  4 , Thomas Weimbs  5 , Jeff S Volek  6
Affiliations
Review

The case for a ketogenic diet in the management of kidney disease

Shaminie J Athinarayanan et al. BMJ Open Diabetes Res Care. .

Abstract

Ketogenic diets have been widely used for weight loss and are increasingly used in the management of type 2 diabetes. Despite evidence that ketones have multiple positive effects on kidney function, common misconceptions about ketogenic diets, such as high protein content and acid load, have prevented their widespread use in individuals with impaired kidney function. Clinical trial evidence focusing on major adverse kidney events is sparse. The aim of this review is to explore the effects of a ketogenic diet, with an emphasis on the pleiotropic actions of ketones, on kidney health. Given the minimal concerns in relation to the potential renoprotective effects of a ketogenic diet, future studies should evaluate the safety and efficacy of ketogenic interventions in kidney disease.

Keywords: Diet; Ketones; Kidney Diseases; Nephrology.

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Conflict of interest statement

Competing interests: TW is an inventor on issued and pending patents filed by the University of California, Santa Barbara related to the topic of this article. TW is a founder and shareholder of Santa Barbara Nutrients, Inc., holds a managerial position, and has contributed to the development of the Ren.Nu ketogenic dietary program and the medical food KetoCitra. TW received speaker fees from Otsuka, was a scientific advisor of Chinook Therapeutics, and received research funding from Chinook Therapeutics. JSV is a cofounder and shareholder of Virta Health, serves as a science advisor for Simply Good Foods and Nutrishus Brands, and has authored books on ketogenic diets. SJA, CGPR, and GKS are employees and shareholders of Virta Health. ALM is a shareholder of Virta Health.

Figures

Figure 1
Figure 1
Summary of pleiotropic renal protective effect of ketones and carbohydrate restriction. BHB, β-hydroxybutyrate; mTORC1, mammalian target of rapamycin complex 1; NLRP3, NOD-, LRR-, and pyrin domain-containing 3; PGC-1ɑ, peroxisome proliferator-activator receptor γ (PPARγ) coactivator-1-alpha; FFAR-3, free fatty acid receptor-3; HCAR, hydroxycarboxylic acid receptor-2; HDAC-3, Histone deacetylase-3; NRF2, nuclear factor erythroid 2-related factor 2; SIRT1, silent information regulator transcript-1.
Figure 2
Figure 2
Ketogenesis pathway. AcAc, acetoacetate; BDH, BHB dehydrogenase; CoA, coenzyme A; HMGCL, hydroxymethylglutaryl coenzyme A lyase; HMG-CoA, hydroxymethylglutaryl CoA; HMGCS2, 3-hydroxy 3-methylglutaryl-CoA synthase 2; CPT1/2, carnitine palmitoyltransferase 1/2; MCT, moncarboxylate transporter.
See this image and copyright information in PMC

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