- Enter age, sex, height, and weight — used to compute a body weight for the protein math (adjusted body weight is applied automatically when BMI ≥ 30).
- Choose the kidney status (normal, a CKD stage, dialysis, or transplant). If you know the eGFR, enter it and it overrides the stage bucket.
- Set diabetes, and flag whether the patient is on an SGLT2 inhibitor, on a RAAS inhibitor or MRA, and whether they have ADPKD / polycystic kidney disease.
- Optionally add the latest potassium, bicarbonate, phosphate, and albuminuria — each sharpens a specific flag.
- Pick the intended carbohydrate level (moderate, low, or keto). The planner returns a protein ceiling, a carbohydrate floor, a risk panel, and a green / amber / red verdict.
All computation runs in your browser; no values are stored or transmitted. This is decision support to bring to your physician and renal dietitian — it is not a prescription.
When to Use
Use this planner whenever a person with kidney disease (or a single kidney, dialysis, a transplant, or an SGLT2 inhibitor on board) is considering a low-carbohydrate or ketogenic diet — or when a clinician wants a fast, guideline-anchored read on whether the typical high-protein/high-fat execution is safe for that patient. It separates the metabolic case (weight, glycemia) from the renal-safety case, and translates KDIGO 2024 and KDOQI 2020 protein targets and the euglycemic-DKA interaction into a plain verdict.
Appropriate population
Anyone with CKD (any stage), on dialysis, transplanted, or with a solitary functioning kidney who is thinking about cutting carbohydrate — and clinicians counseling them. Also useful for a kidney-intact patient with diabetes on an SGLT2 inhibitor, where the euglycemic-DKA guardrail applies regardless of eGFR.
What it does NOT do
It does not prescribe a diet, replace a renal dietitian, or screen for protein-energy wasting on its own (use the linked NRI / SARC-F tools for that). It encodes guideline thresholds and the key safety interactions; the final plan must be individualized with the treating physician.
Pearls & Pitfalls
The protein direction is the whole point
Most people execute low-carb by pushing protein up (1.2–2.0+ g/kg/day). In CKD 3–5 not on dialysis, the guideline direction is the opposite — 0.55–0.8 g/kg/day. A "protein-controlled low-carb" then forces very high fat, which reintroduces the acid and LDL problems. That is why the planner usually lands on a moderate-carb, plant-forward pattern rather than keto.
Keto + SGLT2 inhibitor = euglycemic DKA risk
SGLT2 inhibitors promote ketogenesis; superimposing a ketogenic diet (or fasting/illness) can precipitate ketoacidosis at normal glucose. The planner returns RED for keto + SGLT2i and teaches sick-day rules. Never combine deep ketosis with an SGLT2 inhibitor without physician guidance.
Dialysis runs the other way
Dialysis patients need more protein (1.0–1.2 g/kg) and adequate energy (~25–35 kcal/kg) to avoid protein-energy wasting. A low-carb, energy-restricted pattern risks catabolism — the planner flags this and points to nutrition-risk screening.
Why Use It
The question "is keto safe for my kidneys?" hides several separate answers that depend on stage, dialysis status, diabetes, drug therapy, and recent labs. Clinicians usually reason through protein ceilings, acid load, potassium/phosphorus, the euglycemic-DKA interaction, and energy adequacy one at a time; patients rarely get a single, personalized read. This planner encodes the KDIGO 2024 and KDOQI 2020 protein targets and the key safety interactions so the "green/amber/red" answer and the reason behind it are explicit — and it routes the user to the right deep-dive guide or metric calculator next.
Low-Carb Safety Planner
Enter the profile below. The planner returns a personalized protein window, a carbohydrate floor (with the euglycemic-DKA guardrail), a risk panel across acid / potassium / phosphorus / energy / lipids, and a plain-language verdict.
⚕ Protein targets: CKD 3–5 ND without diabetes 0.55–0.60 g/kg/day (VLPD 0.28–0.43 + keto-analogs, supervised); with diabetes 0.6–0.8; KDIGO general ~0.8 with a hard caution above 1.3 g/kg/day; dialysis 1.0–1.2 g/kg/day plus adequate energy; transplant/normal individualized. Body weight for protein uses adjusted body weight when BMI ≥ 30. The planner never returns a keto "green light" for CKD 4–5 ND, dialysis, or SGLT2i-on-board scenarios without a physician-supervision caveat. Sources: KDOQI 2020, KDIGO 2024, and the euglycemic-DKA literature (see references). Not a prescription.
How to Read Your Result
The verdict supports — it does not replace — your physician and renal dietitian.
- GREEN — carbohydrate quality/quantity control is reasonable for you as described; still keep protein appropriate and the plate plant-forward.
- AMBER — carbohydrate restriction is possible but needs specific safeguards (protein ceiling, alkali/produce, potassium/phosphorus, energy) and supervision; the panel lists which.
- RED — the intended plan collides with a real hazard (protein overload in CKD, euglycemic DKA with an SGLT2 inhibitor, or energy/PEW risk on dialysis). Do not start it as described; bring the panel to your doctor.
- Open the protein window as g/day and compare it against what a low-carb/keto plan would actually deliver — most keto menus exceed it two- to four-fold in CKD.
- Use the "open next" links to the matching deep-dive guide or metric calculator (nutrition prescription, nPCR, recipe analyzer, nutrition-risk screen).
Evidence & References
Protein targets applied
| Population | Protein target | Source |
|---|---|---|
| CKD 3–5 ND, no diabetes | 0.55–0.60 g/kg/day (or VLPD 0.28–0.43 + keto-analogs, supervised) | KDOQI 2020 |
| CKD 3–5 ND, with diabetes | 0.6–0.8 g/kg/day | KDOQI 2020 |
| CKD (general, KDIGO) | ~0.8 g/kg/day; avoid >1.3 g/kg/day if at risk of progression | KDIGO 2024 |
| Dialysis (HD/PD) | 1.0–1.2 g/kg/day + adequate energy | KDOQI 2020 |
| Preferred protein source | Plant > animal; avoid ultra-processed | KDIGO 2024 |
Safety logic encoded
| Trigger | Planner response |
|---|---|
| SGLT2 inhibitor + keto (or fasting) | RED — euglycemic DKA risk; sick-day rules; do not combine |
| High animal-protein pattern + HCO₃⁻ < 22 or stage ≥ 4 | Acid-load flag; add base-producing fruits/vegetables (or bicarbonate) |
| K⁺ ≥ 5.0, or RAASi/MRA + advanced CKD | Potassium flag; avoid potassium-dense low-carb foods |
| PO₄ above ~4.5 mg/dL + high-protein/processed low-carb | Phosphorus flag; CKD-MBD caution |
| Dialysis + carbohydrate/energy restriction | Energy/PEW flag; protect protein and calories |
| Any keto plan | Lipid note; check LDL/ApoB at 6–12 weeks (LMHR caveat) |
| ADPKD | Supervised-keto note; investigational, specialist-only |
Evidence & References
The protein ceilings come from the KDOQI 2020 nutrition guideline and the KDIGO 2024 CKD guideline; the euglycemic-DKA interaction between SGLT2 inhibitors and ketogenic eating is documented in the endocrine literature; and the dialysis energy/protein floors reflect the protein-energy-wasting evidence. Full citations are in the accordion below and in the companion guide.
- Ikizler TA, Burrowes JD, Byham-Gray LD, et al. KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update. Am J Kidney Dis. 2020;76(3 Suppl 1):S1–S107.
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int. 2024;105(4S):S117–S314.
- Ko GJ, Rhee CM, Kalantar-Zadeh K, Joshi S. The Effects of High-Protein Diets on Kidney Health and Longevity. J Am Soc Nephrol. 2020;31(8):1667–1679.
- Mistry S, Eschler DC. Euglycemic Diabetic Ketoacidosis Caused by SGLT2 Inhibitors and a Ketogenic Diet: A Case Series and Review. AACE Clin Case Rep. 2020;7(1):17–19.
