A VLCD including nutritional ketosis is an effective T2D intervention, but its use is cautioned in renal disease. We compared eGFR slope among people with T2D with varying renal function who received a VLCD intervention via continuous remote telemedicine care (CCI, n=262) or Usual Care without carbohydrate restriction (UC, n=87) over two years. Four ketosis trajectory classes (KTs) were identified within CCI using latent class trajectory modeling. We compared eGFR slopes for CCI KTs using a linear mixed effect model with UC as the reference. The eGFR slope was positive in all CCI KTs and negative in UC (Table 1). eGFR slope improved in CCI (p=0.045), in sustained nutritional ketosis (SNK) group (p=0.01), and in those with baseline eGFR <90 (p<0.001) compared with UC. KT with higher blood ketones (SNK and MDNK) had greater eGFR rise. These results show that eGFR slopes rose in people with T2D on CCI and declined in UC. Rise of eGFR slope appears to have a dose-dependent relationship with endogenous ketone concentration and duration of maintenance of ketosis, including those with stage 2 chronic kidney disease, suggesting nutritional ketosis VLCD may provide benefit rather than risk in early renal disease.


S.J.Athinarayanan: Employee; Virta Health Corp. C.G.P.Roberts: Employee; Virta Health Corp. R.N.Adams: Employee; Virta Health Corp. B.M.Volk: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. S.D.Phinney: Board Member; Virta Health Corp., Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp. J.Volek: Stock/Shareholder; Virta Health Corp. A.L.Mckenzie: Employee; Virta Health Corp., Stock/Shareholder; Virta Health Corp.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.