Impact of Low Protein Diet Supplemented With Ketoanalogues Supplementation on Uremic Toxins Production

Inclusion Criteria: * CKD stage 4-5 with estimated glomerular filtration rate \< 30 ml/min/1,73m2 * No dialysis * No history of kidney transplantation * Non-diabetic (fasting glucose \<1.26 g / L, or no insulin or oral antidiabetic therapy) * BMI between 18 and 30 kg / m2 * Patient followed in the nephrology department of Professor FOUQUE at the Lyon Sud hospital * For women of childbearing age, at least one method of contraception recognized as effective * Patient who gave consent to open participation and signed the consent to participate in the study Exclusion Criteria: * Patient with progressive inflammatory, infectious, cardiovascular or neoplastic disease * Patient refusing a dietary follow-up * Patient having a planned transplant or dialysis project in the next 6 months. * Patient having a colectomy, resection of the small intestine or cholecystectomy * Patient who has received antibiotics, prebiotics, probiotics in the last 3 months. * Patient treated with more than 2 g of calcium per day * Patient using laxatives (more than 2 per day) * Patient having: * Uncontrolled metabolic acidosis (bicarbonatemia \<18 mM) * Hyperparathyroidism (PTH greater than 5 times the upper limit of normal) * Hypercalcemia (Calcium\> 2.55 mmol / L) or hypophosphoremia \<0.70 mmol / L * Anemia (hemoglobinemia \<80g / L) * Undernutrition criteria: albumin \<38 g / L or prealbumin \<0.3 g / L * Known hypersensitivity to any of the substances or excipients of Ketosteril * Subject in exclusion period of a previous study * Patient not affiliated to social security * Patient under guardianship or in the interests of justice * Patient who is pregnant, breastfeeding or likely to become pregnant during the study