Ketogenic dietary interventions in autosomal dominant polycystic kidney disease—a retrospective case series study: first insights into feasibility, safety and effects

Abstract

Background Our laboratory published the first evidence that nutritional ketosis, induced by ketogenic diet (KD) or time-restricted diet (TRD), ameliorates disease progression in PKD animal models. We reasoned that, due to their frequent use for numerous health benefits, some ADPKD patients may already have had experience with ketogenic dietary interventions (KDIs). This retrospective case series study is designed to collect first real-life observations of ADPKD patients about safety, feasibility, and possible benefits of KDIs in ADPKD as part of a translational project pipeline. Methods Patients with ADPKD who had already used KDIs were recruited to retrospectively collect observational and medical data about beneficial or adverse effects, the feasibility and safety of KDIs in questionnaire-based interviews. Results 131 ADPKD patients took part in this study. 74 executed a KD and 52 TRD, for 6 months on average. 86% of participants reported that KDIs had improved their overall health. 67% described improvements in ADPKD-associated health issues. 90% observed significant weight loss. 64% of participants with hypertension reported improvements in blood pressure. 66% noticed adverse effects that are frequently observed with KDIs. 22 participants reported safety concerns like hyperlipidemia. 45 participants reported slight improvements in eGFR. 92% experienced KDIs as feasible while 53% reported breaks during their diet. Discussion Our preliminary data indicate that KDIs may be safe, feasible, and potentially beneficial for ADPKD patients highlighting that prospective clinical trials are warranted to confirm these results in a controlled setting and elucidate the impact of KDIs specifically on kidney function and cyst progression.

Metabolism-based approaches for autosomal dominant polycystic kidney disease

“…A self-enrolled survey of ADPKD patients who have self-administered ketogenic diet for at least 6 months reported weight loss and blood pressure lowering together with improvement in PKD symptoms and eGFR in a subgroup of patients. Caution should be applied to the interpretation of this retrospective study since only half of the patients were able to comply with the diet and the side effects reported suggest potential long-term tolerability and safety issues (kidney stones, increased cholesterol) ( Strubl et al, 2021 ). In a follow-up study, Oehm demonstrated the feasibility of a short-term ketogenic intervention in 10 ADPKD patients (RESET-PKD 72h fast or 14 days of a KD) where TLV was decreased while no changes in TKV were observed ( Oehm et al, 2022a ; Oehm et al, 2022b ).…”

Obesity, Weight Loss, Lifestyle Interventions, and Autosomal Dominant Polycystic Kidney Disease

“…In addition, one retrospective case series including 131 PKD patients assessed the role of ketogenic dietary interventions via survey, questionnaire-based interviews, and retrospective medical data to assess potential beneficial or adverse effects. Although there are major limitations to this observational study, including selection bias, the investigators found patients’ experience with ketogenic diets were overall beneficial, safe, and feasible from the interviews [ 130 ]. Only one trial, which included both daily caloric restriction and intermittent fasting, has evaluated abdominal adiposity via magnetic resonance imaging (MRI).…”

Dietary Aspects and Drug-Related Side Effects in Autosomal Dominant Polycystic Kidney Disease Progression

“…In a recent, observational study on a ketogenic diet, just over half of the patients self-enrolled in the study were able to comply with the diet for at least 6 months. Despite some objective and subjective health benefits, the study raised important questions about the long-term tolerability and safety of such interventions [ 36 ]. Tolerability failure to adhere to the ketogenic diet on a daily basis is an issue.…”