Effects of Low Protein Diet Supplemented With Ketoanalogues on Preservation of Kidney Function in Incremental Dialysis

Inclusion Criteria: * Age ≥ 18 years at screening * Stable CKD stage 5 not yet on dialysis with residual kidney function 5-10 ml/min/1.73m2 by CKD-EPI equation * Urine output ≥ 800 ml/day * Willing to participate in the study and can provide inform consent Exclusion Criteria: * Rapid glomerular filtration rate (GFR) progression defined as a decline of eGFR \>10 ml/min/1.73m2 by CKD-EPI equation in the prior 6 months before enrollment * Presence of wasting diseases, cancer cachexia, tuberculosis, AIDS wasting syndrome * Other active infection/inflammation determined by CRP \>10 mg/L * Severe gastrointestinal problem: persistent nausea/vomiting, dysphagia, chronic diarrhea, severe malabsorption * Conditions at baseline requiring withdrawal from the study including severe protein energy wasting by SGA and MIS score, prior kidney transplantation with immunosuppressive agents or other serious medical conditions. * Pregnancy * Uncontrolled hypercalcemia (persistent serum Ca ≥10.5 mg/dl) * BMI ≥ 35 kg/m2 * Hypersensitivity to the active substances or to any of the excipients of Ketosteril * Disturbed amino acid metabolism