Occurrence and features of kidney stones in patients after a ketogenic diet

reference

Acharya P, Acharya C, Thongprayoon C, et al. Frequency and characteristics of kidney stones in patients with ketogenic diet: a systematic review and meta -analysis. diseases . 2021; 9: 39-42.

Study goal

The goal of this meta analysis was to calculate an estimated pottery of kidney stones in patients who comply with a ketogenic diet, and also to determine the most common type of kidney stones.

draft

A systematic overview and meta-analysis of 36 published clinical studies and observation studies (cohort, case control or cross-sectional studies) that reported about the occurrence of kidney stones in people with ketogenic diet.

participant

The literature research, review and selection process finally led to 36 studies with a total of 2,795-pooled participants.

The investigators have queried the following databases: Medline, Embase and Cochrane Database of Systematic Reviews.

The search strategy was mainly used when publishing publications: ('ketogenic diet' or 'keto diet' or 'atkins diet' or 'carbohydrate-low diet' or 'low-carbohydrate diet') and (nephrolithiasis or 'kidney stones' or 'kidney stones'). The initial search resulted in 221 relevant studies. Two independent investigators checked these articles, and a third investigator disabled discrepancies.

study parameters evaluated

The rated parameters included the number of patients, the middle age, gender, the time until the kidney stone was diagnosed with a ketogenic diet, the type of kidney stone, the occurrence of kidney stones and the duration of aftercare.

primary result measurements

The primary endpoints included the appearance and the type of kidney stones.

important knowledge

Incase: The most important result of this study was that the estimated pooled incidence of kidney stones in patients with ketogenic diet with a medium after -observation period of 3.7 ± 2.9 years was 5.9 %.

Since the age was not a restriction, the researchers were able to carry out a subgroup analysis that showed that the estimated pooled incidence of kidney stones in children was 5.8 %, compared to 7.9 % in adults.

Type: In reported studies, 48.7 % of the kidney stones were uric acid stones, 36.5 % stones based on calcium and 27.8 % were mixed stones on uric acid and calcium base.

practice implications

If you consider that the incidence of nephrolithiasis in the general population is given as of 0.3 % per year in men and 0.25 % per year in women, ^{1 Based on the results of this analysis, it becomes clear that follow -up of a ketogenic diet can increase the occurrence of kidney stone formation. Therefore, doctors who prescribe ketogenic diets must weigh whether the advantages of the ketogenic diet outweigh the risks. Patients and clients must also be informed about the increased risk of the formation of kidney stones and strategies for reducing their education.}

Practicers who prescribe ketogenic diets must consider whether the advantages of the ketogenic diet outweigh the risks.

While the exact mechanism of nephrolithiasis is still uncertain, it can probably be related to the chronically acidic physiological state, which often results from a high -fat, moderately protein -rich and basic nutrition. If the liquid absorption is also restricted, the risk of kidney stone formation continues to increase. ^{2 In addition, chronic acidosis leads to bone -ending, increased calcium excretion, 3.4 and even uric acid crystals. 2}

A change in nutrition and other medical/nutritional strategies may have to be implemented, especially in patients with kidney stone formation in the history.

In terms of nutrition, some modification options include:

1. The change of purine -rich animal protein, which has been proven to create a acidic milieu, to vegetable protein, which leads to a lower uric acid excretion.
2. Increase liquid intake to reduce the risk of kidney stone formation.

   In terms of nutritional supplements:

   1. Supplementation with oral potassium citrate that can alkalize the pH value of urine can be justified. It was shown that potassium citrate leads to a reduction in kidney stone formation. In a study, the formation of kidney stones was reduced from 6.75 % to 0.9 % without side effects in participants with ketogenic diet.
   2. sufficient calcium, magnesium and vitamin D levels are also an essential aspect to support bone health.

      In patients with recurrent stone formation, a screening should be considered as part of a holistic and personalized approach regardless of nutrition, which increase the risk of kidney stone formation (i.e. renal sodium citrate co-transporters).

      The duration of the ketogenic diet can also be a factor for the formation of kidney stones. For people who follow a ketogenic diet for weight loss, the risk of developing kidney stones can be reduced if the diet is followed at short notice.

      Ultimately, the authors state: "These results can affect the prevention and treatment of kidney stones in patients treated with ketogenic diets." The awareness of this risk on the part of the doctor and the patient is essential information before continuing with a ketogenic diet.