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. This evidence concerns the gene SLC5A8 and Hyperinsulinemia.