What Is Diabetic Kidney Disease?

Kidneys are a part of the renal system that plays a crucial role in filtering and modulating the amount of water and electrolytes in the blood, maintaining acid-base balance, stimulating production of red blood cells, and regulating blood pressure.¹ Exposure to chronic hyperglycemia in diabetes causes damages to the kidney that can eventually lead to kidney disease.² In diabetic kidney disease (DKD), structural and functional changes to the kidney lead to proteinuria (protein found in urine), hypertension (high blood pressure), and progressive worsening of kidney function.² While the exact pathophysiology of DKD is still being uncovered, possible causes include insulin resistance, genetics, hyperglycemia, and an autoimmune process. Approximately 30-40% of patients with diabetes will eventually develop DKD.²

How Is Diabetic Kidney Disease Usually Managed? 

As having diabetes is associated with a 10 times higher likelihood of developing kidney disease that progresses to end-stage renal disease (ie, kidney disease that requires dialysis),³ it is critical for patients with diabetes to undergo intensive treatment to prevent or delay micro- and macrovascular complications. Current management of DKD includes intensive concurrent management of glucose, blood pressure, and lipids along with lifestyle modifications to potentially slow the progression of DKD.⁴ Intensive lifestyle modifications include healthy weight loss, increased physical activity, and smoking cessation. Mediterranean-style diet with sodium restriction is typically recommended for DKD management.⁴

Does the Ketogenic Diet Help or Harm the Kidneys?

Although more studies are needed, research suggests that the ketogenic diet can potentially be beneficial for improving DKD.^5–7 For instance, a study on the use of ketogenic diet in mice with diabetic nephropathy found that eight weeks of dietary intervention resulted in reversal of diabetic nephropathy as indicated by albumin/creatinine ratios and stress-induced genes.⁶ Other studies propose that the ketogenic diet’s effectiveness in improving insulin resistance, fasting blood glucose, hemoglobin A1c, triglyceride, lipid profiles, weight, waist circumference, and body mass index can alleviate factors that contribute to DKD development.

Currently, the ketogenic diet is not widely used in cases of kidney disease due to misconceptions that it is necessarily high in protein and acid load.⁵ However, the diet focuses on creating a state of ketosis by stringently restricting the consumption of carbohydrate to promote utilization of fat reserves as the primary source of energy instead of glucose.^8–10 It encourages a high fat intake of around 70% of daily caloric intake while suggesting a moderate protein intake, restricted to 20% of daily caloric intake, which meets the current dietary recommendations for kidney disease.^4,11 Additional concern is whether the ketogenic diet promotes metabolic acidosis that can strain the kidneys. However, when carefully prepared to promote mild ketosis and keep ketone levels within normal ranges, the diet may have minimal impact on blood pH, along with other profiles that may affect kidney function.⁵

Researchers indicate that the ketogenic diet can theoretically be used as a safe and effective intervention for DKD in humans, but the verdict is still out.

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