In what may be the most significant dietary intervention result in PKD history, researchers at Juntendo University (Tokyo) presented 12-month interim data at the World Congress of Nephrology 2026 showing that ketogenic metabolic therapy reversed kidney growth in ADPKD patients. The results have been published in Kidney International Reports.
The single-arm open-label trial enrolled 10 patients (7 completed 12 months) with moderate-to-advanced ADPKD (Mayo Imaging Class C or higher, median eGFR 57). The primary finding: Total Kidney Volume (TKV) significantly decreased (paired t-test p=0.026, Wilcoxon p=0.016). In a disease where kidneys typically grow 5-10% per year, these kidneys actually shrank.
Perhaps most compelling was the dose-response relationship: mean blood ketone levels at 3 months showed a strong negative correlation with TKV change (Spearman rho = -0.86, p=0.012). In plain language — patients with higher ketone levels experienced more kidney shrinkage, supporting a causal mechanism rather than coincidence.
Liver volume also significantly decreased at both 3 and 12 months, and eGFR stabilized compared to historical pre-trial decline of approximately -5.6 mL/min/1.73m² per year. The intervention used a structured ketogenic diet with KetoCitra supplementation (BHB + alkaline citrate), individualized dietitian guidance, and digital self-monitoring.
For context, tolvaptan — the only approved PKD drug — merely slows kidney growth from +5.51%/year to +2.80%/year in the TEMPO 3:4 trial. Kidneys still grow on tolvaptan. This ketogenic intervention achieved actual reversal. The full trial has completed enrollment with over 50 participants plus a control group, with final results expected in approximately one year.