Nutritional adequacy of ketogenic diets as a novel dietary intervention for people living with autosomal dominant polycystic kidney disease

BACKGROUND: Diet is a priority to the kidney community, with increasing interest in whether a ketogenic diet can slow autosomal dominant polycystic kidney disease (ADPKD) progression. People with ADPKD have unique nutritional requirements that need to be considered when designing a ketogenic diet for this population. The nutritional adequacy of an ADPKD ketogenic diet needs to be evaluated prior to testing in a clinical trial. OBJECTIVE: The current paper describes the (i) development of an ADPKD-Keto meal plan, in addition to modified PKD-Keto diets targeting the risk of nephrolithiasis and hyperkalemia, (ii) nutritional adequacy of these diets compared to a reference chronic kidney disease (CKD) diet, and (iii) cost-analysis of PKD-Keto meal plans and CKD reference meal plans. METHODS: Dietary guidelines for ADPKD, CKD and general healthy eating were used to develop ketogenic meal plans for people living with ADPKD. All meal plans were analyzed for energy, macronutrient and micronutrient content, and results were compared to dietary intake targets. RESULTS: Caloric and macronutrient targets were achieved, with total carbohydrate, total fat and protein meeting 10%, 75% and 15% of total caloric intake, respectively across PKD-Keto meal plans. Micronutrients were mostly adequate in all meal plans except for iodine in the PKD-Keto meal plans; iron for females aged 19-50; and zinc for males. PKD-Keto diet meal plans were slightly higher in cost, however there was no difference based on socioeconomic area. CONCLUSION: A well-planned ketogenic diet tailored for ADPKD can be nutritionally adequate with supplementation of iodine, iron and zinc to be considered if the diet is to be used for an extended period.