Ren.Nu, a Dietary Program for Individuals with Autosomal-Dominant Polycystic Kidney Disease Implementing a Sustainable, Plant-Focused, Kidney-Safe, Ketogenic Approach with Avoidance of Renal Stressors

Abstract

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of renal failure and has limited pharmacological treatment options. Disease progression is relentless, and regression is not a known feature of ADPKD even with pharmacological intervention. Recent research has uncovered underlying pathogenic mechanisms that may be amenable to dietary interventions. Cyst cells in ADPKD are thought to depend on glucose for energy and are unable to metabolize fatty acids and ketones. High-carbohydrate diets and lifestyles leading to hyperglycemia appear to worsen progression of ADPKD. Additionally, renal stressors such as oxalate, phosphate and uric acid, that lead to renal tubular micro-crystal burden appear to accelerate disease progression. Based on these research findings, we have created a remote, dietitian-supervised training program to teach individuals with ADPKD the implementation of dietary and lifestyle changes to avoid factors that may worsen disease progression. Using web-based platforms, digital tools, one-on-one remote meetings, and video group meetings, participants learn to implement a plant-focused ketogenic diet that avoids renal stressors, the science behind these changes, how to self-measure health parameters, and track nutrient intake. Dietary changes are supplemented with a medical food containing the ketone beta-hydroxybutyrate and alkaline citrate, and mindfulness exercises. Here, we report the first experience with this program from a beta test with approximately 24 participants. Most participants completed the program and reported improvements in their health and well-being including pain levels, weight loss, hypertension, and eGFR. Adherence to the program was very high and the feasibility of the dietary and lifestyle changes was rated highly. The Ren.Nu program is now publicly available to individuals with ADPKD.

Metabolism-based approaches for autosomal dominant polycystic kidney disease

“…Adherence (ketone concentrations), feasibility and secondary outcomes including TKV, and BMI will be evaluated. Based on these findings, Bruen and collaborators have designed a plant-focused ketogenic diet (Ren.Nu diet) for ADPKD based on the theory that a diet high in carbohydrate and animal protein might accelerate disease progression ( Bruen et al, 2022 ). A preliminary beta test was conducted for 12 weeks in 24 ADPKD patients and with the obvious limitations of the study (no control, selection bias, self-reporting).…”

“…A preliminary beta test was conducted for 12 weeks in 24 ADPKD patients and with the obvious limitations of the study (no control, selection bias, self-reporting). Preliminary data suggest reasonable adherence and feasibility ( Bruen et al, 2022 ).…”

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

“…Individuals with autosomal dominant polycystic kidney disease (ADPKD) may benefit from calorie restriction or ketogenic diet 19 130 131. This chronic progressive condition is characterized by hyperproliferation, inflammation, fibrosis, and cyst growth, leading to deterioration of kidney function over time 19 132.…”

“…In humans, a retrospective observational study of ADPKD patients who self-initiated ketosis either using ketogenic or time-restricted diets reported improvement in eGFR after 6 months 134. A pilot study on 24 patients with ADPKD demonstrated the feasibility of the ketogenic diet, reporting high adherence rates and improvements in blood pressure, eGFR, and kidney pain 130. In another exploratory RCT, 66 participants with ADPKD were randomized to ketogenic, water fasting, or control diets.…”

The Importance of Lifestyle Interventions in the Prevention and Treatment of Chronic Kidney Disease

“…In ADPKD, animal experiments have shown potential of ketogenic dietary interventions ameliorating disease progression [5] and first data in humans point towards potential translatability of this approach [6,7]. In this Special Issue, Bruen et al [8] provide a first insight into a potential tailored dietary intervention that may enable the implementation of ketogenic dietary interventions in real life in the future. This aspect is complemented by recent evidence on the role of weight reduction in ADPKD.…”