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Further, KD should not be used in patients with chronic kidney disease, liver failure, hypertriglyceridemia-induced acute pancreatitis, heart failure, especially NYHA Class IV, eating disorders, respiratory failure, as well as in the elderly, and during pregnancy and lactation ( KD is widely used as an adjuvant therapy for many diseases

doi: 10.2147/DDDT.S327378 133

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Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: a randomized clinical trial

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This is called the active (or acute) phase because this is when the physical changes to the spongy tissue are actively happening