For people with kidney disease, following a healthy diet can be challenging. Unlike other health conditions, patients with chronic kidney disease (CKD) have to be more mindful of their nutrition to keep their kidneys and body as healthy as possible. 

While the ketogenic (keto) diet is popular in diet culture right now, is it safe for CKD patients? Learn more about the concerns of a keto diet in CKD.*

What Is The Keto Diet?

All keto diets restrict carbohydrates and are high in fat. Within this general definition, there are multiple versions of the keto that include:

• Standard ketogenic diet (SKD): Low-carb, moderate-protein, and high-fat diet. It typically contains 70% fat, 20% protein, and only 10% carbs. 
• Cyclical ketogenic diet (CKD): Periods of higher-carb refeeds, such as five ketogenic days followed by two high-carb days.
• Targeted ketogenic diet (TKD): This diet allows you to add carbs around workouts.
• High-protein ketogenic diet: This is similar to a standard ketogenic diet but includes more protein. The ratio is often 60% fat, 35% protein, and 5% carbs.

While a keto diet does not necessarily have to be high in protein, the average keto diet consists of 1.2-2.0 grams per kilogram of body weight a day. For many CKD patients, this protein amount may be excessive.

What Makes A Keto Diet Unsafe for CKD Patients?

“By definition, keto diets are very high in fat and protein, and that is challenging for long-term renal health,” said study co-author Neal Barnard, M.D., an adjunct professor of medicine at the George Washington University School of Medicine in Washington, DC, and president of the Physicians Committee for Responsible Medicine.

For CKD patients, there are four main concerns, which include:

• Strain on Diseased Kidneys – Research confirms high-protein diets, specifically from animal sources, increase risks for albuminuria (protein in the urine) in CKD patients. This can reduce kidney function in patients who already have reduced function due to diabetes, hypertension, or infection. 
• Impact on Metabolic Acidosis – A common side effect of CKD is metabolic acidosis, which develops from too much acid in the body. A diet with many fruits and vegetables and less meat can aid in treatment. This is likely not possible with a strict keto diet. 
• CKD with Type 1 Diabetes – For patients with type 1 diabetes, studies show both favorable and unfavorable outcomes. One small study suggested the keto diet improved blood sugar, but it triggered more frequent and extreme hypoglycemic (low blood sugar) episodes in type 1 diabetes patients. 
• Polycystic Kidney Disease (PKD) –  If following a keto diet were to lead a PKD patient to ketosis, studies suggest that ketosis may ameliorate renal cyst growth in patients with PKD. Investigations in animals have shown that keto diets could lead to rapid regression of renal cystic burden. 

For CKD patients, keto diets can be very dangerous. Speak with your doctor and/or a registered dietitian to discuss if the benefits of a keto diet outweigh the risks for you and your health conditions. 

*Schieszer, J., MA. (2021, August 19). The Potential Dangers of Ketogenic Diets in Kidney Disease. Renal and Urology News. https://www.renalandurologynews.com/home/news/nephrology/chronic-kidney-disease-ckd/ketogenic-diet-potentially-harmful-especially-in-patients-with-ckd/

Mawer, R. M. (2020, October 22). The Ketogenic Diet: A Detailed Beginner’s Guide to Keto. Healthline. https://www.healthline.com/nutrition/ketogenic-diet-101#diet-types