Researchers studied whether the ketogenic (keto) diet might help protect kidney health in people with diabetic kidney disease. They looked at diet patterns in a large health survey and tracked blood ketone levels in diabetes patients over time. The study found that people following more keto-like diets had better kidney function markers, and those with higher ketone levels in their blood were less likely to develop severe kidney failure. While promising, this research shows associations rather than proving the keto diet directly prevents kidney problems, so more studies are needed.

The Quick Take

  • What they studied: Whether following a ketogenic diet might protect kidney health in people with diabetes-related kidney disease
  • Who participated: People from a national health survey plus diabetes patients with kidney disease from a Chinese hospital
  • Key finding: Those following more keto-like diets and having higher blood ketone levels showed better kidney function and lower rates of severe kidney failure
  • What it means for you: If you have diabetic kidney disease, a ketogenic diet might help protect your kidneys, but talk to your doctor first since this is early research

The Research Details

The researchers used three different approaches to study this question. First, they analyzed data from a large national health survey to see if people eating more keto-like diets had better kidney function. They calculated a ‘ketogenic ratio’ based on what people reported eating to estimate how ketogenic their diet was. Second, they followed diabetes patients with kidney disease over time, measuring ketone levels in their blood and tracking kidney health. Finally, they used genetic analysis to see if people naturally prone to higher ketone levels had better kidney function.

Using multiple study methods helps strengthen the findings because each approach has different strengths and weaknesses. The cross-sectional data shows associations at one point in time, the longitudinal study tracks changes over time, and the genetic analysis helps suggest whether ketones might actually cause better kidney health rather than just being associated with it.

The study used established health databases and multiple analytical methods, which adds credibility. However, the dietary information relies on people accurately reporting what they eat, which isn’t always reliable. The genetic analysis helps address some limitations of observational studies by reducing confounding factors.

What the Results Show

People following more ketogenic diets showed better kidney function markers and lower rates of end-stage kidney disease. In the survey data, those in the highest ketogenic diet group had significantly lower rates of severe kidney failure compared to those eating the least ketogenic diets. The longitudinal study found that patients with higher blood ketone levels had better kidney survival rates over time. The optimal blood ketone level appeared to be around 0.25 mmol/L, where kidney protection was strongest. The genetic analysis supported these findings, showing that people genetically predisposed to higher ketone levels had better kidney function markers.

The study found that the relationship between ketones and kidney health followed a curve rather than a straight line, meaning there may be an optimal ketone level rather than ‘more is always better.’ People without kidney failure had higher BMI, albumin levels, and ketogenic diet scores compared to those with kidney failure.

This research adds to growing evidence that ketogenic diets might have benefits beyond weight loss. Previous studies have shown mixed results for keto diets in diabetes, but this is among the first to specifically look at kidney protection in diabetic kidney disease using multiple study approaches.

The study cannot prove that ketogenic diets directly prevent kidney failure, only that they’re associated with better outcomes. Dietary information was self-reported, which may not be accurate. The sample size wasn’t specified, and most participants were from one hospital in China, so results may not apply to other populations. More long-term studies are needed to confirm these findings.

The Bottom Line

If you have diabetic kidney disease, discuss ketogenic diets with your healthcare team before making changes. The research suggests potential benefits, but individual medical history and current treatments must be considered. Any dietary changes should be medically supervised, especially with kidney disease.

People with diabetes-related kidney disease and their healthcare providers should pay attention to this research. Those with advanced kidney disease or other serious health conditions should be especially cautious about major dietary changes without medical supervision.

The study tracked patients over time but didn’t specify exact timeframes for seeing benefits. Kidney disease progression is typically slow, so any protective effects would likely take months to years to become apparent.

Want to Apply This Research?

  • Monitor daily carbohydrate intake and aim for ketogenic ratios (high fat, moderate protein, very low carb) while tracking kidney function markers if available
  • Gradually reduce carbohydrate intake while increasing healthy fats, tracking ketone levels with urine strips or blood meters to maintain levels around 0.25 mmol/L
  • Track daily macronutrient ratios, weekly ketone measurements, and coordinate with healthcare providers to monitor kidney function markers like creatinine levels over time

This information is for educational purposes only and should not replace professional medical advice. People with kidney disease or diabetes should consult their healthcare provider before making significant dietary changes, as individual medical needs vary and some dietary modifications may not be appropriate for all patients.