Halting cyst progression in ADPKD using long-term ketogenic metabolic therapy and supplementation with exogenous ketones and alkaline citrate-a case series.
Level 4 - case-series / case-control
Retrospective case series of 4 individuals without a concurrent control group.
PubMed 42445794 · doi:10.3389/fnut.2026.1843178
What was done
This retrospective case series evaluated four self-referred adults (ages 33–71) with genetically confirmed truncating PKD1 variants who independently adopted metabolic interventions. Interventions varied in duration (6 months to approximately 4 years) and intensity, including carbohydrate restriction, intermittent fasting, and supplementation with a ketone- and citrate-based medical food (KetoCitra). Serial clinical abdominal imaging was re-analyzed using standardized volumetric software to measure total kidney volume (TKV), liver volume, and Mayo imaging classification trajectories relative to prior phases of documented kidney enlargement.
What was found
Across all four cases, TKV stabilized or decreased relative to prior growth trajectories during the intervention periods, and kidney function was reported as preserved (specific numeric values for TKV and renal function were not reported in the abstract). One patient shifted downward from Mayo Class 1C to 1B, and the other three demonstrated downward trajectory shifts within their existing Mayo classifications. Attenuation or reduction in liver volume was also noted in participants with polycystic liver disease, with no serious adverse events reported.
Why it matters
Autosomal dominant polycystic kidney disease has limited disease-modifying treatment options. These observations suggest ketogenic metabolic strategies and alkaline citrate supplementation may influence cystic progression, providing a rationale for formal prospective controlled trials.
Limits
The study is limited by an extremely small sample size (n = 4), a retrospective design relying on self-referred patients, and high heterogeneity in the timing, adherence, and specific components of the self-implemented diets and supplements. Confounding cannot be excluded, and the abstract lacks exact numerical values for kidney volumes, rate of decline, and renal function metrics.
Cited by
- supports Consuming fewer carbohydrates reduces cyst formation, while consuming more sugar and alcohol increases cyst growth.