Mildly Elevated Ketone Levels Linked to Lower Kidney Risk in Type 2 Diabetes, Finds Study
South Korea: Researchers have found in a new study that among patients with type 2 diabetes not using insulin or thiazolidinediones, higher ketone body levels within a mild hyperketonemic range were associated with better kidney outcomes. Those in the highest ketone tertile had a 37% lower risk of major adverse kidney events compared with those in the lowest tertile. The lowest kidney risk was seen at ketone levels of approximately 300–400 µmol/L, suggesting a potentially protective association between mild ketosis and kidney health.
The findings, published in Diabetes Research and Clinical Practice by Soo Myoung Shin of the Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea, and colleagues, examined whether circulating ketone body concentrations were associated with subsequent kidney and cardiovascular complications in people with type 2 diabetes.
The prospective cohort included 1,392 clinically stable patients with type 2 diabetes who were not receiving insulin or thiazolidinedione treatment. Researchers measured total serum ketone body concentrations during stable outpatient visits and divided participants into three groups according to their ketone levels: 0.08–92.3, 92.7–170.8, and 171.0–1629.6 µmol/L.
Kidney outcomes assessed during follow-up included the development of macroalbuminuria, a decline in estimated glomerular filtration rate (eGFR) of at least 40%, and end-stage kidney disease. Cardiovascular events included myocardial infarction, coronary revascularization, ischemic stroke, hospitalization for heart failure, and cardiovascular death.
Over a median follow-up of 23.2 months, researchers recorded 158 kidney events and 64 cardiovascular events.
The following were the key findings:
- The highest ketone tertile was associated with a 54% lower risk of a ≥40% decline in eGFR compared with the lowest tertile (aHR, 0.46).
- Higher ketone levels were linked to a 37% lower risk of composite adverse kidney outcomes.
- Among participants with baseline eGFR ≥60 mL/min/1.73 m², the risk of developing chronic kidney disease was 50% lower in the highest ketone group.
- Higher ketone levels showed favorable trends for cardiovascular outcomes, but the associations were not statistically significant.
- Overall, mildly elevated ketone levels were associated with better kidney outcomes in patients with type 2 diabetes who were not using insulin or thiazolidinediones.
- Because the study was observational, the findings do not establish that higher ketone levels directly protect against kidney disease.
Overall, the results raise the possibility that mild hyperketonemia may serve as a marker or mediator of reduced kidney risk in type 2 diabetes, warranting further research to clarify the underlying mechanisms and determine whether modifying ketone body levels could have clinical implications.
Reference:
Shin, S. M., Lee, J., Kim, Y., Kim, J. A., Kim, K. J., Kim, K. J., Kim, H. Y., Kim, S. G., & Kim, N. H. (2026). Serum ketone body levels and risk of incident kidney and cardiovascular events among patients with type 2 diabetes: A prospective cohort study. Diabetes Research and Clinical Practice, 239, 113476. https://doi.org/10.1016/j.diabres.2026.113476
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