The effect of a low-carbohydrate diet on renal dysfunction in patients with metabolic disorders. Description of clinical cases
https://doi.org/10.36485/1561-6274-2025-29-4-91-99
EDN: XUYNJD
Abstract
Currently, the leading factors in the development and progression of chronic kidney disease (CKD) are type 2 diabetes mellitus and arterial hypertension, which are often caused by obesity resulting from overeating. The literature clearly shows that a properly selected diet has a beneficial effect not only on blood pressure and carbohydrate metabolism, but also on kidney function. The presence of CKD in most cases assumes comorbidity, and therefore requires the selection of an optimal diet that includes correction of all existing metabolic disorders. Today, there are more than 100 diets known, but it remains unclear which one is best for these patients. Moreover, the effect of major macronutrients on renal function remains controversial and has not been fully studied. The article describes three clinical cases of a low-carbohydrate diet (LCD) with moderate carbohydrate intake and its effect on renal function and metabolic parameters. This dietary option in patients with metabolic disorders, combined with high patient adherence to the diet, led to improved kidney function and carbohydrate, lipid and purine metabolism indicators, weight loss, a reduction in the doses and number of medications used, and in some cases helped to normalise blood pressure.
About the Authors
N. V. KhudyakovaSerbia
Prof. Khudiakova Natalia Valerevna, MD, PhD
11070, Beograd, Pariske komune 24
tel. (+381) 011 2623 475
S. Stojanovich Srdjan Stojanovich
Serbia
Prof. Srdjan Stojanovich, PhD, Dr. Sci. (Chem.)
11070, Srbia, Beograd, Pariske komune 24
tel. (+381) 011 2623 475
D. Radoichich
Serbia
Lecturer Daniela Radoichich
11070, Srbia, Beograd, Pariske komune 24
tel. (+381) 011 2623 475
Yu. S. Khudyakov
Serbia
Prof. Yurij Sergeevich Khudyakov, PhD, Dr. Sci. (Chem.)
36210, Serbia, Vrnjaсhka Banja, Lipovacka 9G
tel. (+381) 062 649 858
I. Yu. Pchelin
Russian Federation
Pchelin Ivan Yurevich, MD, PhD
199106, St-Peterburg, 21 line VO 8a
Phone: +7 (812) 326-03-26
S. O. Mazurenko
Russian Federation
Prof. Mazurenko Sergey Olegovich, MD, PhD, DMedSci
199106, Russia, St-Peterburg, 21 line VO 8a
Phone: +7 (812) 326-03-26
V. V. Smirnov
Russian Federation
Smirnov Victor Vladimirovich, MD
194100 St-Peterburg, Litovskaya street 2
Phone: +7 9210958072
A. D. Kotrova
Russian Federation
Kotrova Anna Dmitrievna MD
199106, St-Peterburg, 21 line VO 8a
Phone: +7 (812) 326-03-26
V. N. Vasilkova
Belarus
Vasilkova Volha Nikolaevna, PhD
246000, Belarus, Gomel, Lange 5
Phone: +37829 730-10-27
References
1. Theodorakis N, Nikolaou M. From Cardiovascular-Kidney-Metabolic Syndrome to Cardiovascular-RenalHepatic-Metabolic Syndrome: Proposing an Expanded Framework. Biomolecules 2025;15:213. https:// doi.org/10.3390/biom15020213
2. Filiinyuk PY, Rumyantsev AS, Pchelin IY, Khudyakova NV, Volovnikova VA. Cardiometabolic profiles in patients with ischaemic heart disease, stage 5 chronic kidney disease and obesity. Translational Medicine 2022;9:S2:143
3. Vasilkova V, Pchelin I, Bayrasheva V, Khudyakova N, Savasteeva I, Mokhort T. The role of inflammatory markers and growth factors in progression of chronic kidney disease in patients with diabetes mellitus. Journal of Renal Injury Prevention 2024. doi: 10.34172/jrip.2023.32188
4. Khudyakova NV, Pchelin IY, Shishkin AN, Smirnov VV, Ivanov NV, Makarenko MV, Bayrasheva VK, Staroselsky KG. Hyperhomocysteinemia in men with metabolic syndrome and early stages of chronic kidney disease. Arterial Hypertension 2017;23:141–149
5. Clinical recommendations. Chronic kidney disease (CKD). Nephrology (Saint-Petersburg) 2021;25(5):10–82. (In Russ.) doi: 10.24884/1561-6274-2021-25-5-10-82
6. Clemente-Suárez, VJ, Mielgo-Ayuso, J, Martín-Rodríguez A, Ramos-Campo, DJ, Redondo-Flórez, L,Tornero-Aguilera JF. The Burden of Carbohydrates in Health and Disease. Nutrients 2022;14:3809. https://doi.org/10.3390/nu14183809
7. Nam, KH, An SY, Joo YS, Lee S, Yun HR, Jhee JH, Han SH, Yoo TH, Kang SW, Park JT. Carbohydrate-Rich Diet Is Associated with Increased Risk of Incident Chronic Kidney Disease in Non-Diabetic Subjects. J Clin Med 2019;8:793
8. Farhadnejad H, Asghari G, Emamat H, Mirmiran P, Azizi F. Low-Carbohydrate High-Protein Diet Is Associated With Increased Risk of Incident Chronic Kidney Diseases among Tehranian Adults. J Ren Nutr Off J Counc Ren Nutr Natl Kidney Found 2019;29:343–349
9. Zaki H, Iftikhar H, Bashir K. A Comparative Study Evaluating the Effectiveness Between Ketogenic and Low-Carbohydrate Diets on Glycemic and Weight Control in Patients With Type 2. Diabetes Mellitus: A Systematic Review and Meta-Analysis. Cureus 2022;14(5): e25528. doi: 10.7759/cureus.25528
10. Ivannikova E, Altashina M, Troshina E. The ketogenic diet: history, mechanism of action, indications and contraindications. Problems of Endocrinology 2022;68(1):49–72. (In Russ.) https://doi.org/10.14341/probl12724
11. Oh R, Gilani B. Low-Carbohydrate Diet In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Affiliations Expand PMID: 30725769 Bookshelf ID: NBK537084
12. Asghar G, Momenan M, Yuzbashian E, Mirmiran P, Azizi F. Dietary Pattern and Incidence of Chronic Kidney Disease among Adults: A Population-Based Study. Nutr Metab 2018;15:88
13. Yuzbashian E, Asghari G, Mirmiran Р, Hosseini FS, Azizi F. Associations of Dietary Macronutrients with Glomerular Filtration Rate and Kidney Dysfunction: Tehran Lipid and Glucose Study. J Nephrol 2015,28,173–180
14. Kim H, Lee H, Kwon SH, Jeon JS, Noh H, Han DC, Kim H. Relationship between Carbohydrate-to-Fat Intake Ratio and the Development of Chronic Kidney Disease: A Community-Based Prospective Cohort Study. Clin Nutr 2021;40:5346–5354
15. Nieuwdorp M, Meuwese MC, Vink H, Hoekstra JBL, Kastelein JJP, Stroes ESG. The Endothelial Glycocalyx: A Potential Barrier between Health and Vascular Disease. Curr Opin Lipidol 2005;16:507–511
16. Bruci A, Tuccinardi D, Tozzi R, Balena A, Santucci S, Frontani R, Mariani S, Basciani S, Spera G, Gnessi L et al. Very Low-Calorie Ketogenic Diet: A Safe and Effective Tool for Weight Loss in Patients With Obesity and Mild Kidney Failure. Nutrients 2020;12:333
17. Ko GJ, Obi Y, Tortorici AR, Kalantar-Zadeh K. Dietary Protein Intake and Chronic Kidney Disease. Curr Opin Clin Nutr Metab Care 2017;20:77–85
18. Bagriy AВ, Khomenko MV, Shverova OI, Titievskaya ER. Therapy approaches in diabetic nephropathy (review of literature). Nephrology (Saint-Petersburg) 2021;25(1):18–30. (In Russ.) https:// doi.org/10.36485/1561-6274-2021-25-1-18-30
19. Baranovsky AY, Mazurenko SO. Therapeutic nutrition of elderly people with kidney diseases. Nephrology (Saint-Petersburg) 2025;29(3):8–30.(In Russ.) https://doi.org/10.36485/1561-6274-2025-29-3-8-30
20. Mirmiran P, Yuzbashian E, Asghari G, Sarverzadeh S, Azizi F. Dietary Fibre Intake in Relation to the Risk of Incident Chronic Kidney Disease. Br J Nutr 2018;119:479–485
21. Maino Vieytes CA, Taha HM, Burton-Obanla AA, Douglas KG, Arthur AE. Carbohydrate Nutrition and the Risk of Cancer. Curr Nutr Rep 2019;8:230–239
22. Carrero JJ, González-Ortiz A, Avesani CM, Bakker SJL, Bellizzi V, Chauveau P, Clase CM, Cupisti A, Espinosa-Cuevas A, Molinа P et al. Plant-Based Diets to Manage the Risks and Complications of Chronic Kidney Disease. Nat Rev Nephrol 2020;(16):525–542
23. Dinh, QN, Drummond GR, Sobey CG, Chrissobolis S. Roles of Inflammation, Oxidative Stress, and Vascular Dysfunction in Hypertension. Biomed Res Int 2014;2014:406960
24. Judd E, Calhoun DA. Management of Hypertension in CKD: Beyond the Guidelines. Adv Chronic Kidney Dis 2015;(22):116–122
25. Rinninella E, Mele MC, Merendino N, Cintoni M, Anselmi G, Caporossi A, Gasbarrini A, Minnella AM. The Role of Diet, Micronutrients and the Gut Microbiota in Age-Related Macular Degeneration: New Perspectives from the Gut–Retina Axis. Nutrients 2018;(10):1677
26. Rosas-Villegas A, Sánchez-Tapia M, Avila-Nava A, Ramírez V, Tovar AR, Torres N. Differential Effect of Sucrose and Fructose in Combination with a High Fat Diet on Intestinal Microbiota and Kidney Oxidative Stress. Nutrients 2017;(9):393
27. Ling S, Sweeting M, Zaccardi F, Adlam D, Kadam UT. Glycosylated haemoglobin and prognosis in 10,536 people with cancer and pre-existing diabetes: a meta-analysis with dose-response analysis. BMC Cancer 2022;22:1048 https://doi.org/10.1186/s12885-022-10144-y
Review
For citations:
Khudyakova N.V., Srdjan Stojanovich S.S., Radoichich D., Khudyakov Yu.S., Pchelin I.Yu., Mazurenko S.O., Smirnov V.V., Kotrova A.D., Vasilkova V.N. The effect of a low-carbohydrate diet on renal dysfunction in patients with metabolic disorders. Description of clinical cases. Nephrology (Saint-Petersburg). 2025;29(4):91-99. (In Russ.) https://doi.org/10.36485/1561-6274-2025-29-4-91-99. EDN: XUYNJD
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