Chronic kidney disease (CKD) is often viewed as a progressive condition with few dietary options beyond restricting protein and specific minerals. However, emerging evidence suggests that ketogenic diets may be beneficial for those with impaired kidney function.
In this article, we’ll explore how ketogenic diets may affect kidney health, including what we know so far from human studies and how the approach may apply to specific types of CKD like autosomal dominant polycystic kidney disease (ADPKD).
What is chronic kidney disease?
CKD is characterized by a gradual decline in kidney function over time. The kidneys play a central role in filtering waste from the blood, regulating electrolytes, controlling blood pressure, and maintaining fluid balance. A diagnosis of CKD is made when estimated glomerular filtration rate (eGFR) drops below 60 mL/min/1.73 m² for more than three months, or when there is evidence of kidney damage, such as proteinuria.
CKD is divided into five stages based on eGFR, with Stage 1 being mild and Stage 5 indicating kidney failure requiring dialysis or transplantation.
Most common types of CKD
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Diabetic kidney disease (aka diabetic nephropathy) develops when high blood glucose damages kidney filtering structures over time. This is the leading cause of CKD, affecting approximately 40% of people with type 2 diabetes and 30% of people with type 1 diabetes.
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Hypertensive kidney disease (aka hypertensive nephrosclerosis) occurs when chronic high blood pressure leads to scarring and reduced filtration capacity. Hypertension is a leading cause of CKD, second only to diabetes.
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Polycystic kidney disease (PKD) is a genetic disorder in which fluid-filled cysts form and enlarge within the kidneys, leading to gradual loss of function. Autosomal Dominant Polycystic Kidney Disease (ADPKD) accounts for approximately 90% of all PKD cases and is caused by inherited mutations in the PKD1 or PKD2 genes.
Risk factors for CKD
- Type 2 diabetes and prediabetes.
- High blood pressure.
- Obesity and metabolic syndrome.
- Smoking.
- Age over 60.
- Family history of CKD and especially ADPKD.
- Chronic long-term use of NSAIDs such as ibuprofen.
What does the research say about ketogenic diets and CKD?
Ketogenic diets have been shown to reduce insulin levels, improve glycemic control, and promote weight loss – all of which are important in the context of kidney health. Some kidney specialists and researchers have proposed that ketogenic interventions may be a safe and effective nutrition therapy for metabolically driven forms of chronic kidney disease, such as those related to type 2 diabetes, insulin resistance, and/or hypertension. Ketogenic approaches may improve metabolic health, support kidney function, and address underlying causes such as obesity and poor glycemic control.
By contrast, other researchers and health professionals caution against ketogenic diets in people with kidney disease because of their potential to promote metabolic acidosis, raise the risk of kidney stones, and increase acid load, especially when the diet relies heavily on animal proteins.
Unfortunately, human clinical research in this area is very limited. However, a few studies in people with type 2 diabetes suggest that in addition to lowering blood glucose and reducing insulin resistance, ketogenic or very-low-carb diets may improve blood pressure and stabilize or improve markers of kidney health:
- In a two-year study of more than 200 adults with type 2 diabetes, those who participated in a continuous remote care intervention (CCI) designed to promote nutritional ketosis showed greater improvements in blood pressure, blood glucose, A1c, weight, and other markers compared to those in the control group who followed a standard diet.
- Five years later, the researchers published a post-hoc analysis showing that CCI participants had increases in eGFR and higher rates of CKD stage improvement than controls, with over half of those in stage 3 improving to stage 2 and none progressing. Sustained nutritional ketosis was associated with the greatest kidney function gains, reduced inflammation, and stable markers such as blood urea nitrogen.
- Another team of researchers reviewed the literature on low-carbohydrate diets and kidney health in type 2 diabetes and also analyzed real-world clinical data. In a primary care cohort of 143 patients with normal kidney function or mild CKD who followed a very-low-carb diet for an average of 30 months, patients experienced an increase in eGFR and decreases in creatinine and urinary albumin-to-creatinine ratio.
Evidence for ketogenic diets in ADPKD
One of the most promising emerging areas of research is the use of ketogenic interventions for ADPKD, with several studies reporting encouraging results:
- In the RESET-PKD pilot trial, 10 patients with ADPKD and rapid disease progression were assigned to either a three-day water fast or a 14-day ketogenic diet. Both interventions successfully induced ketosis in most participants and were rated as feasible, with 9 of 10 patients reaching the metabolic target and reporting adherence. Kidney volume did not change over the short intervention, but total liver volume decreased by about 7.7%, and participants also experienced weight loss and improved body composition.
- In a three-month randomized trial by some of the same researchers who conducted the RESET-PKD study, 131 patients with ADPKD completed a ketogenic intervention, following either a continuous ketogenic diet or a three-day-per-month water-fasting regimen. Both approaches were feasible and safe, resulting in improvements in body weight, blood pressure, and kidney function markers.
- The Ren.Nu program is a 12-week remote, dietitian-led clinical program for people with ADPKD. In one study, 24 participants completed the program’s plant-focused ketogenic diet, which limited renal stressors such as oxalate, phosphate, and excess animal protein while supplementing with the medical food KetoCitra®. Most of the participants lost weight, improved blood pressure and blood glucose, maintained ketosis, and showed favorable changes in kidney function markers such as eGFR and serum creatinine, while reporting high adherence and satisfaction.
- In a larger cohort of 103 adults with ADPKD participating in the 12-week Ren.Nu program, eGFR increased by 6.3% on average, along with a 4.5% reduction in BMI and improvements in metabolic health. Among those taking antihypertensive medications, 50% were able to reduce or discontinue use, and more than half of participants reporting kidney pain experienced improvement. Safety markers, including lipids, electrolytes, and bicarbonate, remained stable, supporting the feasibility and tolerability of this approach.
- In a retrospective case series, 131 patients with ADPKD reported following a ketogenic or time-restricted eating regimen for about six months. Most of the participants experienced weight loss, lower blood pressure, and improvements in PKD-related symptoms, while kidney function often stabilized or improved in those achieving ketosis. Side effects were generally mild and transient, and the diets were reported as feasible and safe.
Potential ways to support kidney health through diet and lifestyle
- Manage blood glucose and insulin: Keeping blood glucose and HbA1c in a healthy range is essential for reducing the progression of diabetic kidney disease.
- Reduce blood pressure: Weight loss and carbohydrate reduction can help lower blood pressure, a major driver of kidney damage.
- Avoid excessive protein intake: Ketogenic diets can be tailored to meet protein targets based on kidney function, with 0.8 to 1.0 grams per kilogram of ideal body weight considered an appropriate target for most people with mild to moderate loss of kidney function in both CKD and ADPKD. Although a feasibility study of a modified Atkins diet that did not restrict protein found no worsening of kidney function in individuals with ADPKD, this was a very small (n=3) trial, and the results cannot be generalized to other ADPKD patients. Additionally, individuals with more advanced CKD or ADPKD may need to maintain protein intake at or slightly below 0.8 grams per kilogram of ideal body weight to help preserve kidney function. A registered dietitian can make specific protein recommendations based on individual needs.
- Choose keto-friendly plants but minimize renal stressors: Although including animal protein helps support muscle maintenance and dietary adherence, research suggests that a plant-rich ketogenic diet may offer additional benefits for kidney disease by reducing acid load. However, non-plant-focused ketogenic diets have also shown favorable effects in people with CKD and ADPKD. Because individuals with ADPKD are particularly susceptible to kidney damage from crystal formation, it’s important to limit foods high in oxalate (e.g., spinach, other leafy greens, nuts, and seeds) and phosphates (e.g., cola beverages, processed meats, and packaged foods containing phosphate additives, which are often identified by ingredients with “phos” in the name).
- Monitor electrolytes and hydration: Individuals with kidney disease often need adjustments to their sodium, potassium, and fluid intake. A registered dietitian can help individualize these recommendations to support kidney function and overall safety.
Final Thoughts on Ketogenic Diets for Chronic Kidney Disease
Growing evidence suggests that well-formulated ketogenic diets may support kidney health by improving metabolism and reducing risk factors such as insulin resistance, inflammation, and hypertension, particularly in people with obesity, type 2 diabetes, or ADPKD. However, more research is needed to clarify their long-term effects and identify which patients may benefit the most. Because chronic kidney disease is complex, it’s important to follow a ketogenic diet under professional supervision. With the right guidance, it may help protect kidney function and enhance overall quality of life.
