Do you recommend a ketogenic diet for patients with autosomal dominant polycystic kidney disease?

So far, what we know based on pilot studies is that the keto diet "doesn't not work" in PKD. I tell this to patients and some are motivated to pursue it, which should be done in a supervised way and focus on fat from salmon and avocado rather than super high saturated fat options where possible. Some find this helps them "clean up" their diets to focus on better, unprocessed choices. I think that can be advantageous, but I also think achieving a true keto state for a prolonged period is quite difficult. Overall, a balanced Mediterranean-style diet with plenty of water for hydration is my usual recommendation.