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A paper published recently in Molecular Biology Reports highlights various mechanisms by which very low carb diets or ketogenic diets (KDs) may be helpful for chronic kidney disease (CKD). Although research supports use of these diets for a wide array of medical conditions, exploration regarding efficacy for CKD is a new, emerging area.
Being that diabetes, hypertension, and obesity are among the strongest risk factors for CKD, it stands to reason that KDs may at least have the potential for therapeutic benefit, as this way of eating has been shown to facilitate weight loss, help put type 2 diabetes into remission and improve hypertension to the point where antihypertensive medication can be reduced or eliminated. Interestingly, the paper makes little mention of these more obvious factors and instead discusses reduced oxidative stress, reduced inflammation, reduced kidney fibrosis, and improved mitochondrial function as possible contributing mechanisms.
Unfortunately, most of the research cited in the paper are preclinical animal studies, but recent years have seen a few human studies published. In a study published last year looking at renal function in a small cohort of patients following a low-carbohydrate diet (LCD), patients with normal renal function or mild CKD experienced significant improvements in serum creatinine as well as in glycemic control and cardiovascular risk factors.
Carbohydrate restriction appears to also be beneficial among those with more advanced kidney disease. A retrospective cohort study looking at changes in estimated glomerular filtration rate (eGFR) in patients prescribed a LCD determined, “for patients with mildly reduced and moderately to severely reduced kidney function who were prescribed an LCD, their estimated glomerular filtration rate was either unchanged or improved. For those with normal or elevated eGFR, their kidney function was slightly decreased.”
There may be some concern regarding the amount of protein in a KD, but this way of eating is, first and foremost, very low in carbohydrate. The majority of calories come from fat, and protein intake can be targeted for individual needs across a range of total grams or percentage of daily calories.