My nephrologist said no to a ketogenic diet and KetoCitra®.

Doctor Standing with Stethoscope

What Now?

Navigating the challenges of Polycystic Kidney Disease (PKD) can often feel like a solitary endeavor, especially when your ideas about self-care aren’t shared by your healthcare provider.

Having hope, as a PKD patient, often hinges on feeling empowered – the belief that your actions could potentially influence the trajectory of your disease progression. In the context of PKD diets and Ketogenic Dietary Interventions (KDI) and KetoCitra®, such options can be lifelines. Their emergence has not only given hope but also imbued a sense of control over the progression of our PKD diagnosis.

But what if your nephrologist doesn’t share your enthusiasm or commitment to these lifestyle changes and what do you do if your nephrologist isn’t on board with your desire to implement a Ketogenic diet tailored for PKD and KetoCitra® into your treatment plan?

This, believe it or not, isn’t a rare dilemma.

Until ketogenic dietary therapies for PKD and KetoCitra® secure more widespread acceptance as feasible PKD management strategies, you might encounter resistance when expressing your intent to include them in your daily regimen. PKD is one of many types of kidney diseases, and finding a physician specializing in PKD is a rarity. Though their primary role is to ensure your optimum health, manage symptoms, and stave off complications, you, as a proactive patient, have conducted your due diligence and are ready to embrace these changes for the optimal health of your kidneys. Remember, any alterations to your regimen, be it diet, medication, or supplements, should be communicated with your nephrologist.

Here are some tips to help you navigate this discussion with your doctor

The first step is self-advocacy. This is key and of the utmost importance in receiving the best medical care. Ensure you are well-informed about what you’re advocating for. Prepare to elucidate the ‘how’, ‘what’, and ‘why’ of Ketogenic Dietary Interventions (KDI) or KetoCitra®. Be prepared to highlight key aspects of your KDI program.

Keto Diet

The term ‘keto‘ can trigger misconceptions, with many doctors associating it with high protein, saturated fat, and imbalanced nutrient intake. Understand the foundations of Ketogenic Dietary Interventions like the Ren.Nu plant-based ketogenic diet, such as:

  • Ketogenic Therapy
  • Intermittent Fasting (as appropriate)
  • Focus on Healthy Fat Sources
  • Reduced (not eliminated) Animal Sources
  • Oxalate Management
  • Adequate Fruits and Vegetables
  • A Nutrient-Dense Diet with a Whole Foods Approach
  • Building a Resilient Mindset

Explain to your doctor that KDI’s like the Ren.Nu program are personalized to individual nutritional needs and lab results. It is not a one-size-fits-all approach. Assure them that your progress will be monitored for 15 weeks by a dietitian who will track your labs, symptoms, intake, and any side effects.


As for KetoCitra®, enlighten your physician about the potential benefits it may offer to your PKD nutrition plan, such as:

  • It contains crucial electrolytes that help reduce the absorption of oxalate and phosphate from the diet which can form harmful microcrystals in kidneys.
  • It replenishes electrolytes that might be depleted when following a ketogenic diet, mitigating ‘keto-flu’ symptoms.
  • It delivers beta-hydroxybutyrate (BHB), a ketone that supports nutrition for PKD and a ketogenic state.
  • It contains citrate, which promotes alkalinity and optimal urine pH levels, and helps to normalize the urinary citrate level which helps to protect from harmful calcium microcrystals in kidneys.

However, keep in mind that KetoCitra® is typically suggested for stages 1-3 of kidney disease. In the later stages of PKD, managing potassium might become more challenging. It’s crucial to understand your lab results and their implications before incorporating any changes into your regimen.

As you converse with your physician, clarify your motives for these changes and how a Ketogenic Diet Intervention and/or KetoCitra® could aid you in achieving them. Be assertive in proposing how your doctor can oversee these additions, which may entail more frequent appointments or lab tests. Open yourself up to increased monitoring as recommended by your physician.

If your doctor remains unconvinced, you may want to consider collaborating with a PKD focused dietitian or another medical professional well-versed in these topics. They might be able to provide a more detailed explanation of a Ketogenic Dietary Intervention and/or KetoCitra® to your doctor or write a letter vouching for these additions to your plan.

Remember, it’s crucial to adhere to your doctor’s advice and recommendations. Equip yourself with the information above to engage in a productive dialogue with your doctor, to educate them if necessary, and to earn their support for your wellness journey.

If you’d like to take a deeper dive, be sure to explore our PKD Tool Kit where you’ll find resources to share with your practitioner, helpful education and other information about diet, chronic kidney disease, polycystic kidney disease (PKD), oxalates, plant-based diets, and other nutritional topics all in one place.

Additional resources:

fresh vegetablesConsider printing out these resources and bringing them to your next appointment with your doctor.

(1) Our recent scientific paper in a clinical nephrology journal. This paper summarizes the details of the Ren.Nu dietary program that uses KetoCitra, and the qualitative outcomes for a group of individuals with PKD during a beta test of the program:

Bruen, D. M.; Kingaard, J. J.; Munits, M.; Paimanta, C. S.; Torres, J. A.; Saville, J.; Weimbs, T. Ren.Nu, a Dietary Program for Individuals with Autosomal-Dominant Polycystic Kidney Disease Implementing a Sustainable, Plant-Focused, Kidney-Safe, Ketogenic Approach with Avoidance of Renal Stressors. Kidney and Dialysis 2022, 2 (2), 183–203.

(2) A scientific paper from the lab of Thomas Weimbs, professor at the University of California Santa Barbara and founder of Santa Barbara Nutrients. This paper reports a retrospective case series study of 131 individuals with PKD and their experience with ketogenic dietary interventions during an average 6 months time period.

Strubl, S.; Oehm, S.; Torres, J. A.; Grundmann, F.; Haratani, J.; Decker, M.; Vuong, S.; Kaur Bhandal, A.; Methot, N.; Haynie-Cion, R.; Meyer, F.; Siedek, F.; Korst, U.; Müller, R.-U.; Weimbs, T. Ketogenic Dietary Interventions in Autosomal-Dominant Polycystic Kidney Disease (ADPKD)– A Retrospective Case Series Study: First Insights into Feasibility, Safety and Effects. Clinical Kidney Journal 2021, 15, 1034–1036.
–> PDF file available here

(3) Results from a prospective, randomized controlled clinical trial of ketogenic dietary interventions in individuals with PKD. This is a blog post previewing the results. The scientific paper will be published soon.

“Clinical feasibility study results suggest diet’s benefit against polycystic kidney disease.”

(4) Results from an informal survey of Ren.Nu participants about the effect on pain. The formal publication in the scientific literature is in progress.

“Pain Improvement in Polycystic Kidney Disease Among Participants of the Ren-Nu Program.”

By: Kelly Welsh, RD


Kelly Welsh brings more than 15 years of experience to the field of nutrition. She is currently a Registered and Certified Dietitian in the state of Wisconsin and works at The Kidney Nutrition Institute.  Kelly’s primary area of interest is renal dietetics, with a focus on Polycystic Kidney Disease and Nutrition.

Beginning her career in clinical nutrition, with a focus on oncology nutrition, Kelly developed an interest for renal dietetics when she was diagnosed with Polycystic Kidney Disease in 1997.

Learn more about Kelly here:

Leave a comment: