{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:33:50Z","timestamp":1784039630793,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["2025ZNSFSC0006"],"award-info":[{"award-number":["2025ZNSFSC0006"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>This study aims to explore the effect of the ketogenic diet (KD) on the occurrence of end\u2010stage renal disease (ESRD) and the longitudinal relationship between circulating \u03b2\u2010hydroxybutyrate (\u03b2\u2010OHB) and kidney outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used the dietary ketogenic ratio (DKR) to estimate the nutritional ketosis probability of KD and analyzed the association with ESRD using NHANES cross\u2010sectional data by Spearman correlation coefficient and multivariate logistic regression model. We also used the Kaplan\u2013Meier method, Cox regression analysis, and restricted cubic splines (RCS) to analyze the relationship between circulating \u03b2\u2010OHB and renal outcomes in the T2DM\u2010DKD longitudinal cohort of West China Hospital. Mendelian randomization (MR) was also employed to evaluate potential causal associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cross\u2010sectional analysis revealed that non\u2010ESRD patients had significantly higher baseline age, BMI, serum albumin, and DKR values, with a weak negative correlation between DKR and serum creatinine (<jats:italic>\u03c1<\/jats:italic>\u2009=\u2009\u22120.072, <jats:italic>p<\/jats:italic>\u2009=\u20090.011). Logistic regression consistently indicated a reduced ESRD prevalence in higher DKR quartiles. In the longitudinal study, elevated \u03b2\u2010OHB levels were associated with improved renal survival and a lower risk of ESRD, with RCS analysis identifying the lowest risk at approximately 0.25\u2009mmol\/L. MR analyses supported these findings, showing inverse correlations between genetically predicted \u03b2\u2010OHB and creatinine (<jats:italic>p<\/jats:italic>\u2009=\u20090.007) and cystatin c (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These findings suggest that KD may be associated with a lower incidence of ESRD in DKD patients, with elevated \u03b2\u2010OHB levels independently associated with a reduced risk of ESRD, warranting further research to confirm causality and elucidate underlying mechanisms.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1753-0407.70140","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T12:45:15Z","timestamp":1755002715000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Ketogenic Diet, Serum Ketone Bodies and Risk of End\u2010Stage Renal Disease in Patients With Diabetic Kidney Disease: A Multi\u2010Cohort Study"],"prefix":"10.1111","volume":"17","author":[{"given":"Ke","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Nephrology West China Hospital of Sichuan University  Chengdu China"},{"name":"Laboratory of Diabetic Kidney Disease, Kidney Research Institute, Department of Nephrology West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Nephrology West China Hospital of Sichuan University  Chengdu China"},{"name":"Laboratory of Diabetic Kidney Disease, Kidney Research Institute, Department of Nephrology West China Hospital, Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanlin","family":"Lang","sequence":"additional","affiliation":[{"name":"Department of Nephrology West China Hospital of Sichuan University  Chengdu 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