Increased absorption and utilization of BHB is part of the metabolic flexibility of the renal tubular epithelial cells under starvation and hypoxic conditions, which exerts a protective effect on renal tubular epithelial cells by improving the mitochondrial function and cell survival, while hyperinsulinemia inhibits the absorption of BHB via inhibition of the SIRT3/SMCT1 pathway. Here, SIRT3 is linked to Hyperinsulinemia.