Study Design
Retrospective, longitudinal, baseline-controlled program evaluation. 103 ADPKD participants with analyzable data from 151 completers. 3-month intervention plus 1-month orientation. Data collected March 2021 - September 2023. Eligibility: confirmed ADPKD + eGFR > 30 mL/min/1.73 m2. Demographics: age 50 +/- 10.7 years, 68.9% female, BMI 25.0 +/- 4.4, baseline eGFR 58.4 +/- 21.07.
Intervention
Ren-Nu Program: KetoCitra daily (5.3g BHB, 3.5g citric acid, 600mg potassium, 300mg calcium, 250mg magnesium, 51 mEq alkaline base, sodium-free) + very-low-carb, high-fat, moderate-protein ketogenic diet (target blood BHB >= 0.5 mmol/L) + plant-focused, kidney-safe nutrition (low oxalate, no inorganic phosphate additives) + fully remote delivery with weekly group meetings + 3 individualized nutrition coaching sessions.
Key Results
eGFR: +6.3% (P<0.0001)
Increased from 58.4 to 61.6 mL/min/1.73 m2 (n=77).
BMI: -4.5%
Significant reduction (n=35).
Blood Pressure Meds: 50% reduced/stopped
Of 24 patients on antihypertensives: 5 discontinued, 7 decreased dosage, 11 no change, 1 increased (P=0.039).
Kidney Pain: 52% reduction
Of 27 patients with pain: 52% experienced reduction, 0% increase (P<0.0001).
Lipids: No adverse changes
Total cholesterol, HDL, LDL, triglycerides all remained stable. Potassium and bicarbonate unchanged.
Significance
The largest real-world dataset on ketogenic metabolic intervention in ADPKD demonstrates clinically meaningful improvements in kidney function, pain, and medication burden. The safety profile is reassuring — no adverse lipid changes despite the high-fat diet, and potassium/bicarbonate levels remained normal despite supplementation. These results support the rationale for ongoing randomized controlled trials.