Ketogenic diets in chronic kidney disease patients: a review for skeptics by skeptics

Over the last few decades, there has been growing interest in the use of ketogenic diets, mainly as a weight loss strategy. Obesity and diabetes are major risk factors for kidney disease, and obese patients with chronic kidney disease (CKD) are potential candidates for weight reducing diets, among them ketogenic diets. Of further relevance to nephrology, a limited number of recent studies suggests a favorable effect of ketogenic diets in patients affected by autosomal dominant polycystic kidney disease (ADPKD). However, concerns remain about safety in patients with CKD, particularly in the long term and in those with poor residual kidney function. The confusion surrounding the definition of ketogenic diets adds to these concerns. The aim of this review is to summarize information on the main types of ketogenic diets used in daily practice and to discuss the options for their implementation in CKD patients, limiting ultra-processed or industrial preparations.Although further studies are needed to identify the profile of CKD patients who may benefit from the implementation of ketogenic diets to treat obesity or slow the progression of ADPKD, and to assess short- and long-term safety and adherence, the available data appear promising. This critical review is intended to stimulate further research.