Risk factors for urolithiasis in children on the ketogenic diet

Area of Science:

• Pediatric Nephrology
• Metabolic Disorders
• Neurology

Background:

• The ketogenic diet is an established therapy for drug-resistant epilepsy in children.
• Kidney stone formation (urolithiasis) has been anecdotally linked to ketogenic diet use.
• Identifying risk factors is crucial for managing potential complications.

Purpose of the Study:

• To investigate risk factors associated with kidney stone development in children on the ketogenic diet.
• To determine the incidence of urolithiasis in a cohort of children initiating the ketogenic diet.

Main Methods:

• A case-control study compared children with ketogenic diet-associated stones to non-stone-forming controls.
• Prospective follow-up of 112 children initiating the ketogenic diet evaluated stone incidence.
• Urine parameters including calcium, creatinine, pH, and citrate were analyzed.

Main Results:

• Younger age at initiation and hypercalciuria were identified as risk factors for stones.
• The incidence of stone formation was 0.8 children per 100 patient-months at risk.
• Elevated fasting urine calcium:creatinine ratios increased from 40% at baseline to 75% at 6 months.
• Urinary citrate excretion significantly decreased on the ketogenic diet.
• Patients often exhibited hypercalciuria, acidic urine, and low urinary citrate.

Conclusions:

• Children on the ketogenic diet are at high risk for uric acid and calcium stones.
• Risk factors include younger age, hypercalciuria, acidic urine, and low urinary citrate.
• Monitoring and potential interventions are necessary to mitigate stone risk.