Kidney Week

Abstract: PO1219

Short-Term Ketogenic Interventions Are Feasible and Effective in Triggering Ketosis in Autosomal Dominant Polycystic Kidney Disease (ADPKD): Results from the RESET-PKD Study

Session Information

• Cystic Kidney Disease - I
  November 04, 2021 | Location: On-Demand, Virtual Only
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1001 Genetic Diseases of the Kidneys: Cystic

Authors

• Oehm, Simon, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Simon Oehm, MD

• Steinke, Konstantin, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Konstantin Steinke,

• Arjune, Sita, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Sita Arjune,

• Todorova, Polina, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Polina Todorova,

• Lindemann, Christoph, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Christoph Lindemann,

• Wöstmann, Fabian, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Fabian Wöstmann,

• Meyer, Franziska Inka, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Franziska Inka Meyer,

• Siedek, Florian, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Florian Siedek,

• Weimbs, Thomas, University of California Santa Barbara, Santa Barbara, California, United States

Thomas Weimbs,

• Grundmann, Franziska, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Franziska Grundmann,

• Mueller, Roman-Ulrich, Universitat zu Koln, Koln, Nordrhein-Westfalen, Germany

Roman-Ulrich Mueller,

Background

Short-term ketogenic dietary interventions slow disease progression in animal models of ADPKD. The RESET-PKD study translates these promising results to a pilot study in humans.

Methods

10 ADPKD patients with rapid disease progression were enrolled (baseline V1) and initially followed their usual carbohydrate-rich diet for up to 4 weeks. At visit 2 (V2) patients chose to either perform a 3-day water fast (WF) or a 14-day ketogenic diet (KD) until V3 and returned to their normal nutrition until V4. MRI kidney volumetry was performed at all visits. Ketone bodies were evaluated at all visits and in between. Feasibility was examined using questionnaires.

Results

All participants (KD: n=5, WF: n=5; age 39.8±11.6 years; eGFR 82±23.5 ml/min; TKV 2224±1156 ml) were classified as Mayo Class 1C to 1E. The dietary interventions did not alter serum creatinine (V2: 1.17±0.33 mg/dl vs. V3: 1.20±0.35 mg/dl, p = 0.826) but serum glucose levels decreased significantly (V2: 84±3 mg/dl, V3: 70±13 mg/dl, p = 0.004). Acetone levels in breath as well as BHB blood levels increased in both study arms (average acetone before dietary intervention (V1 to V2): 2.6±1.18 ppm, on diet (V3): 22.8±11.9 ppm, p< 0.0001; BHB before dietary intervention: 0.22±0.08 mmol/l, on diet: 1.89±0.92 mmol/l, p<0.0001). 9 out of 10 patients reached a ketogenic state during the intervention and 90 % evaluated ketogenic interventions as feasible. No significant TKV changes were observed (ΔTKV V1 to V2: +0.75±0.54%, ΔTKV V2 to V3: -1.06±1.16%).

Conclusion

RESET-PKD shows that ADPKD patients adhere to short-term ketogenic interventions, reliably reach ketosis without ADPKD-specific adverse effects, and judge this diet as feasible in every-day life. Short-term ketogenic interventions did not lead to a significant reduction in TKV or serum creatinine. Larger clinical trials examining longer-term dietary interventions will be crucial to further evaluate long-term feasibility and the therapeutic potential of ketogenic diets in ADPKD.