Halting Cyst Progression in ADPKD Using Ketogenic Metabolic Therapy and KetoCitra: A Case Study

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is a progressive genetic disorder marked by cyst growth and declining kidney function. Despite available pharmacologic therapies, most patients ultimately require dialysis or transplant. This case study presents one-year outcomes from a 36-year-old male patient with ADPKD who implemented a non-pharmacologic nutritional and lifestyle intervention. Case Description: The patient followed a whole-food, nutrient-dense ketogenic diet combined with intermittent fasting and daily use of KetoCitra®—a medical food delivering the exogenous ketone beta-hydroxybutyrate (BHB), citrate, alkaline base, potassium, calcium and magnesium. KetoCitra® is intended to support ketosis while mitigating the lithogenic risk. Serial laboratory assessments included eGFR, serum creatinine, uric acid, glucose metabolism markers, lipid profile, and urinalysis. Total kidney volume (TKV) was measured using AI-based MRI analysis via TRACE (www.traceorg.com). Blood ketone and glucose levels were monitored regularly. Ketone levels were consistently above 0.5 mmol/L, indicating sustained nutritional ketosis and strong adherence. eGFR remained >90 mL/min and serum creatinine were stable over 12 months. Uric acid, HbA1c, and electrolytes stayed within optimal ranges. Ultrasound and MRI analysis suggested that renal growth stabilized, with a trend toward reduction in total kidney volume (TKV). The patient reported increased energy, improved metabolic flexibility, and no adverse events. Despite LDL-C >300 mg/dL, HDL-C exceeded 100 mg/dL and triglycerides remained <80 mg/dL, consistent with a lean mass hyper-responder (LMHR) profile. CAC score was 0, indicating no coronary artery calcification. Discussion: This case highlights the potential of a non-pharmacologic ketogenic intervention—including fasting and exogenous citrate/BHB supplementation—in stabilizing renal health and possibly reducing TKV in ADPKD. No adverse clinical effects were observed from the LMHR phenotype, despite common concerns. Controlled studies are warranted to evaluate the broader therapeutic value of such strategies.