How might Low Carb and Ketogenic Diets affect the Progression of Chronic Kidney Disease?
DOI:
https://doi.org/10.47611/jsr.v12i4.2178Keywords:
low carbohydrate diet, diabetes, obesity, renal function, ketogenic dietAbstract
Background: Obesity, an ever-increasing cause for deaths in the American population, often leads to complications such as Type II Diabetes Mellitus. Both obesity and diabetes predispose to renal disease, which can be ameliorated by treatment of both disorders. Ketogenic and Low Carb diets (KD/LCD) can lower blood sugar of T2DM patients and accelerate weight loss. Diet is a potential factor in slowing the rate of decline in kidney function. Yet, high diet acid loads, as from keto acid, may promote renal damage. Here, we evaluate existing studies on the benefits or harms of KD/LCD on factors associated with renal disease progression.
Methods: Reviews and analysis of existing studies on chronic kidney disease and Ketogenic diets. We analyzed eGFR, the measure of the rate of change in decline of renal function to infer the effects of Ketogenic and Low Carb diets.
Results: Nine of the 22 papers reviewed were analyzed. Studies included from 18 to 1797 participants and included healthy subjects, those with diabetes and /or obesity, and those with normal renal function or moderate kidney failure (eGRF ranged from 94 ± 12 mL/min/ to 40 ml/min/1.73m2). Study duration ranged from 5 weeks to 6 years. Several studies demonstrated improvements, including decreases in serum creatinine, urinary albumin, weight loss, and eGFR.
Conclusions: Renal function improved in shorter studies of diabetics who demonstrated weight loss. Longer studies or those in nondiabetics demonstrated no change in renal function.
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World Health Organization. Obesity and Overweight Fact Sheet. Accessed from http://www.who.int/dietphysicalactivity/media/en/gsfs_obesity.pdf July 2020
Sherrier M, Li H. The impact of keto-adaptation on exercise performance and the role of metabolic-regulating cytokines. Am J Clin Nutr. 2019 Sep 1;110(3):562-573. doi: 10.1093/ajcn/nqz145. PMID: 31347659.
Winocour PH. Diabetes and chronic kidney disease: an increasingly common multi-morbid disease in need of a paradigm shift in care. Diabet Med. 2018 Mar;35(3):300-305. doi: 10.1111/dme.13564. Epub 2018 Jan 8. PMID: 29247554.
Goraya N, Simoni J, Jo C, Wesson DE. Dietary acid reduction with fruits and vegetables or bicarbonate attenuates kidney injury in patients with a moderately reduced glomerular filtration rate due to hypertensive nephropathy. Kidney Int. 2012;81(1):86-93. doi:10.1038/ki.2011.313
Ziedman, Emily, et al. “How Many Grams of Carbs Per Day Should You Eat on Keto?” Perfect Keto, 30 Mar. 2020, perfectketo.com/30-grams-carbs/.
Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999 Nov-Dec;15(6):412-26. doi: 10.1002/(sici)1520-7560(199911/12)15:6<412::aid-dmrr72>3.0.co;2-8. PMID: 10634967.
The Editors of Encyclopedia Britannica. “Ketosis.” Encyclopedia Britannica, Encyclopedia Britannica, Inc., 8 Aug. 2019, Accessed from www.britannica.com/science/ketosis.
Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. 2020 Dec 14. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–. PMID: 29763005.
Cahill GF Jr. Fuel metabolism in starvation. Annu Rev Nutr. 2006;26:1-22. doi: 10.1146/annurev.nutr.26.061505.111258. PMID: 16848698.
Nyenwe EA, Kitabchi AE. The evolution of diabetic ketoacidosis: An update of its etiology, pathogenesis and management. Metabolism. 2016 Apr;65(4):507-21. doi: 10.1016/j.metabol.2015.12.007. Epub 2015 Dec 19. PMID: 26975543.
“Adult Obesity Prevalence Maps.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 29 Oct. 2019, www.cdc.gov/obesity/data/prevalence-maps.html.
Diabetes and Obesity; The UK Is the Fattest Country in Europe. The Number of Obese Adults Is Forecast to Rise by 73% over the next 20 Years from to 26 Million People, Resulting in More than a Million Extra Cases of Type 2 Diabetes, Heart Disease and Cancer Diabetes, 21 Nov. 2019, (accessed 12/10/20 at www.diabetes.co.uk/diabetes-and-obesity.html)
Feinman RD, Pogozelski WK, Astrup A, Bernstein RK, Fine EJ, Westman EC et al.. Dietary carbohydrate restriction as the first approach in diabetes management: critical review and evidence base. Nutrition. 2015 Jan;31(1):1-13. doi: 10.1016/j.nut.2014.06.011. Epub 2014 Jul 16. Erratum in: Nutrition. 2019 Jun;62:213. PMID: 25287761.
Yancy WS Jr, Foy M, Chalecki AM, Vernon MC, Westman EC. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab (Lond). 2005 Dec 1;2:34. doi: 10.1186/1743-7075-2-34. PMID: 16318637; PMCID: PMC1325029.
Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, Hobbs FD. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PLoS One. 2016 Jul 6;11(7):e0158765. doi: 10.1371/journal.pone.0158765. PMID: 27383068; PMCID: PMC4934905.
Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. 2019 Oct 1;322(13):1294-1304. doi: 10.1001/jama.2019.14745. PMID: 31573641; PMCID: PMC7015670.
Baum MA. Outcomes after renal transplantation for FSGS in children. Pediatr Transplant. 2004 Aug;8(4):329-33. doi: 10.1111/j.1399-3046.2004.00181.x. PMID: 15265156.
Curhan GC, Willett WC, Rimm EB, Speizer FE, Stampfer MJ. Body size and risk of kidney stones. J Am Soc Nephrol. 1998; 9:1645-1652.
Qi C, Mao X, Zhang Z, Wu H. Classification and Differential Diagnosis of Diabetic Nephropathy. J Diabetes Res. 2017;2017:8637138. doi: 10.1155/2017/8637138. Epub 2017 Feb 20. PMID: 28316995; PMCID: PMC5337846.
:~:text=Diabetic%20nephropathy%20is%20a%20serious,diabetes%20eventually%20develop%20kidney%20disease
Kostogrys RB, Franczyk-Zarow M, Maslak E, Topolska K. Effect of low carbohydrate high protein (LCHP) diet on lipid metabolism, liver and kidney function in rats. Environ Toxicol Pharmacol. 2015 Mar;39(2):713-9. doi: 10.1016/j.etap.2015.01.008. Epub 2015 Jan 23. PMID: 25766070.
Helms, Natalie. “Ketogenic Diet: What Are the Risks?” UChicago Medicine, UChicago Medicine, 20 June 2019, Accessed from www.uchicagomedicine.org/forefront/health-and-wellness-articles/ketogenic-diet- what-are-the-risks#:~:text=The%20keto%20diet%20could%20cause,%2C%20liver%2C%20thyroid%20or%20gallbladder.
Chen W, Abramowitz MK. Metabolic acidosis and the progression of chronic kidney disease. BMC Nephrol. 2014 Apr 3;15:55. doi: 10.1186/1471-2369-15-55. PMID: 24708763; PMCID: PMC4233646.
Kraut JA, Madias NE. Metabolic Acidosis of CKD: An Update. Am J Kidney Dis. 2016 Feb;67(2):307-17. doi: 10.1053/j.ajkd.2015.08.028. Epub 2015 Oct 23. PMID: 26477665.
Fagherazzi G, Vilier A, Bonnet F, Lajous M, Balkau B, Boutron-Rualt MC, Clavel-Chapelon F. Dietary acid load and risk of type 2 diabetes: the E3N-EPIC cohort study. Diabetologia. 2014 Feb;57(2):313-20. doi: 10.1007/s00125-013-3100-0. PMID: 24232975.
Gottlieb S. High protein diet brings risk of kidney stones. BMJ. 2002;325(7361):408.
Maalouf NM, Cameron MA, Moe OW, Sakhaee K. Metabolic basis for low urine pH in type 2 diabetes. Clin J Am Soc Nephrol. 2010 Jul;5(7):1277-81. doi: 10.2215/CJN.08331109. Epub 2010 Apr 22. PMID: 20413437; PMCID: PMC2893060.
Schwandt A, Denkinger M, Fasching P, Pfeifer M, Wagner C, Weiland J, Zeyfang A, Holl RW. Comparison of MDRD, CKD-EPI, and Cockcroft-Gault equation in relation to measured glomerular filtration rate among a large cohort with diabetes. J Diabetes Complications. 2017 Sep;31(9):1376-1383. doi: 10.1016/j.jdiacomp.2017.06.016. Epub 2017 Jul 5. PMID: 28711195.
Mitchell NS, Scialla JJ, Yancy WS Jr. Are low-carbohydrate diets safe in diabetic and nondiabetic chronic kidney disease? Ann N Y Acad Sci. 2020 Feb;1461(1):25-36. doi: 10.1111/nyas.13997. Epub 2019 Jan 15. PMID: 30644556; PMCID: PMC6629514.
Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012 Oct;28(10):1016-21. doi: 10.1016/j.nut.2012.01.016. Epub 2012 Jun 5. PMID: 22673594.
Tay J, Thompson CH, Luscombe-Marsh ND, Noakes M, Buckley JD, Wittert GA, Brinkworth GD. Long-Term Effects of a Very Low Carbohydrate Compared With a High Carbohydrate Diet on Renal Function in Individuals With Type 2 Diabetes: A Randomized Trial. Medicine (Baltimore). 2015 Nov;94(47):e2181. doi: 10.1097/MD.0000000000002181. PMID: 26632754; PMCID: PMC5059023.
Farhadnejad H, Asghari G, Emamat H, Mirmiran P, Azizi F. Low-Carbohydrate High-Protein Diet is Associated With Increased Risk of Incident Chronic Kidney Diseases Among Tehranian Adults. J Ren Nutr. 2019 Jul;29(4):343-349. doi: 10.1053/j.jrn.2018.10.007. Epub 2018 Dec 19. PMID: 30579675.
Friedman AN, Ogden LG, Foster GD, Klein S, Stein R, Miller B et al. Comparative effects of low-carbohydrate high-protein versus low-fat diets on the kidney. Clin J Am Soc Nephrol. 2012 Jul;7(7):1103-11. doi: 10.2215/CJN.11741111. Epub 2012 May 31. PMID: 22653255; PMCID: PMC3386674.
Tirosh A, Golan R, Harman-Boehm I, Henkin Y, Schwarzfuchs D, Rudich A et al. Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial. Diabetes Care. 2013 Aug;36(8):2225-32. doi: 10.2337/dc12-1846. Epub 2013 May 20. PMID: 23690533; PMCID: PMC3714527.
Bruci A, Tuccinardi D, Tozzi R, Balena A, Santucci S, Frontani R, Mariani S, Basciani S, Spera G, Gnessi L, Lubrano C, Watanabe M. Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients With Obesity and Mild Kidney Failure. Nutrients. 2020 Jan 27;12(2):333. doi: 10.3390/nu12020333. PMID: 32012661; PMCID: PMC7071259.
Friedman AN, Chambers M, Kamendulis LM, Temmerman J. Short-term changes after a weight reduction intervention in advanced diabetic nephropathy. Clin J Am Soc Nephrol. 2013 Nov;8(11):1892-8. doi: 10.2215/CJN.04010413. Epub 2013 Aug 8. PMID: 23929927; PMCID: PMC3817909.
Kovesdy CP, Furth SL, Zoccali C; World Kidney Day Steering Committee. Obesity and Kidney Disease: Hidden Consequences of the Epidemic. Can J Kidney Health Dis. 2017 Mar 8;4:2054358117698669. doi: 10.1177/2054358117698669. PMID: 28540059; PMCID: PMC5433675.
Shahbazian H, Rezaii I. Diabetic kidney disease; review of the current knowledge. J Renal Inj Prev. 2013 Jun 1;2(2):73-80. doi: 10.12861/jrip.2013.24. PMID: 25340133; PMCID: PMC4206005.
Suyoto PST. Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta-analysis. Diabetes Metab Res Rev. 2018 Oct;34(7):e3032. doi: 10.1002/dmrr.3032. Epub 2018 Jul 3. PMID: 29904998.
Helms, Natalie. “Is the Keto Diet Safe? What Are the Risks?” Is the Keto Diet Safe? What Are the Risks? - UChicago Medicine, UChicago Medicine, 20 June 2019, Accessed from www.uchicagomedicine.org/forefront/health-and-wellness-articles/ketogenic-diet-what-are-the-risks#:~:text=The%20keto%20diet%20could%20cause,%2C%20liver%2C%20thyroid%20or%20gallbladder.
Laffel L. Ketone bodies: a review of physiology, pathophysiology and application of monitoring to diabetes. Diabetes Metab Res Rev. 1999 Nov-Dec;15(6):412-26. doi: 10.1002/(sici)1520-7560(199911/12)15:6<412::aid-dmrr72>3.0.co;2-8. PMID: 10634967.
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