FOXO3 and diabetic kidney disease: β-Hydroxybutyrate can decrease kidney ischemia and reperfusion injury by activating FOXO3 and inhibiting pyroptosis (35), while a 1,3-butanediol-rich (a precursor to BHB) diet diminishes macrophage infiltration, interstitial fibrosis, apoptosis, and albuminuria, subsequently reversing diabetic nephropathy (36).