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This paper describes the details of the Ren-Nu ketogenic nutritional intervention program for autosomal-dominant polycystic kidney disease and reports the qualitative experiences of participants.

Abstract: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited

cause of renal failure and has limited pharmacological treatment options. Disease progression is

relentless, and regression is not a known feature of ADPKD even with pharmacological intervention.

Recent research has uncovered underlying pathogenic mechanisms that may be amenable to dietary

interventions. Cyst cells in ADPKD are thought to depend on glucose for energy and are unable to

metabolize fatty acids and ketones. High-carbohydrate diets and lifestyles leading to hyperglycemia

appear to worsen progression of ADPKD. Additionally, renal stressors such as oxalate, phosphate

and uric acid, that lead to renal tubular micro-crystal burden appear to accelerate disease progression.

Based on these research findings, we have created a remote, dietitian-supervised training program to

teach individuals with ADPKD the implementation of dietary and lifestyle changes to avoid factors

that may worsen disease progression. Using web-based platforms, digital tools, one-on-one remote

meetings, and video group meetings, participants learn to implement a plant-focused ketogenic diet

that avoids renal stressors, the science behind these changes, how to self-measure health parameters,

and track nutrient intake. Dietary changes are supplemented with a medical food containing the

ketone beta-hydroxybutyrate and alkaline citrate (KetoCitra), and mindfulness exercises. Here, we report the first

experience with this program from a beta test with approximately 24 participants. Most participants

completed the program and reported improvements in their health and well-being including pain

levels, weight loss, hypertension, and eGFR. Adherence to the program was very high and the

feasibility of the dietary and lifestyle changes was rated highly. The Ren-Nu program is now publicly

available to individuals with ADPKD.