Li Junle, He Wanhong, Wu Qianshi, Qin Yuanyuan, Luo Changfang, Dai Zhuojun, Long Yang, Yan Pijun, Huang Wei, Cao Ling
Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
Sichuan Clinical Research Center for Diabetes and Metabolic Diseases, Luzhou, Sichuan, 646000, China.
BMC Nephrol. 2025 Mar 7;26(1):127. doi: 10.1186/s12882-025-04019-0.
Diabetic kidney disease (DKD) is the main cause of end-stage renal disease. Ketogenic diets (KD) is a high-fat, low-carbohydrate diet. KD produces ketone bodies to supplement energy in the case of insufficient glucose in the body. β-Hydroxybutyrate (BHB) is the main component of ketone bodies. BHB serves as "ancillary fuel" substituting (but also inducing) anti-oxidative, anti-inflammatory, and cardio-protective features by binding to several target proteins, including histone acylation modification, or G protein-coupled receptors (GPCRs). KD have been used to treat epilepsy, obesity, type-2 diabetes mellitus, polycystic ovary syndrome, cancers, and other diseases. According to recent research, KD and the induced BHB delay DKD progression by improving the metabolism of glucose and lipids, regulating autophagy, as well as alleviating inflammation, oxidative stress and fibrosis. However, due to some side-effects, the role and mechanism of action of KD and BHB in the prevention and treatment of DKD are controversial. This review focuses on recent progress in the research of KD and BHB in clinical and preclinical studies of DKD, and provides new perspectives for DKD treatment.
糖尿病肾病（DKD）是终末期肾病的主要原因。生酮饮食（KD）是一种高脂肪、低碳水化合物的饮食。在体内葡萄糖不足的情况下，KD会产生酮体来补充能量。β-羟基丁酸（BHB）是酮体的主要成分。BHB作为“辅助燃料”，通过与几种靶蛋白结合，包括组蛋白酰化修饰或G蛋白偶联受体（GPCR），发挥抗氧化、抗炎和心脏保护作用（同时也诱导这些作用）。KD已被用于治疗癫痫、肥胖、2型糖尿病、多囊卵巢综合征、癌症和其他疾病。根据最近的研究，KD和诱导产生的BHB通过改善葡萄糖和脂质代谢、调节自噬以及减轻炎症、氧化应激和纤维化来延缓DKD的进展。然而，由于一些副作用，KD和BHB在DKD防治中的作用及作用机制存在争议。本综述重点介绍了KD和BHB在DKD临床和临床前研究中的最新进展，并为DKD治疗提供了新的视角。
