Ketogenic diet as rescue therapy to access transplantation in obese and advanced stage IV-CKD patients: a case report and literature review

Kidney transplantation represents the best therapy for kidney failure, but obesity can limit access to this therapeutic option. Therapeutic strategies, such as diet or bariatric surgery, should be considered for obese patients with kidney failure. Unfortunately, there are no guidelines available to manage obesity in Chronic Kidney Disease (CKD). Reducing energy intake is necessary to manage obesity. This usually entails a protein intake of at least 1 g/kg of body weight, contrary to what is recommended by CKD guidelines. To date, bariatric surgery is the best strategy for weight loss, but is not indicated in some conditions, such as in patients with major mood disorders. We present the case of a woman with CKD stage G4A2, metabolic syndrome, and anxiety-depressive disorder. She was not eligible for transplantation because of morbid obesity, or for bariatric surgery due to her major mood disorder. An individualised ketogenic diet was prescribed to give her a chance to access the kidney transplantation waitlist. During the dietary treatment, there was no worsening of kidney function or any adverse effects, and the patient lost 11.7 kg. In selected cases, ketogenic diet could represent a rescue therapy for obese CKD patients allowing them access to the kidney transplantation program.