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Keto-analogues are substances that can be transformed into amino acids by the body. They do not contribute to the production of nitrogen waste product, which would be additional stress for an impaired kidney. Taken as a supplement to a reduced protein diet, they may help to postpone the start of dialysis and thus improve the quality of life as compared to dialysis.
 

The ketogenic diet is a very low carbohydrate, high fat diet that shares many similarities with the Atkins or other low carb diets. It involves drastically reducing carbohydrate intake and replacing it with fat/proteins, thereby forcing the body to burn fats rather than carbohydrates for energy.

Normally carbohydrates in food are converted into glucose, which is then – among other things – used to fuel brain function. However, if only a little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies, the latter passing into the brain and replacing glucose as an energy source. An elevated state of ketone bodies in the blood is called ketosis. This is where the ketogenic diet has derived its name from.

This diet was originally developed in the 1920s to treat hard-to-control epilepsy in children. Today it is sometimes used to purely lose weight. No beneficial effect of this ketogenic diet has been proven for chronic kidney disease.

A protein-reduced diet is used to relieve kidneys in patients with chronic kidney disease.  Metabolic waste products generated when breaking down proteins to amino acids are normally excreted via the kidneys. In CKD patients with impaired kidney function, they cannot be eliminated properly, accumulate and lead to uremic symptoms. Therefore, patients not yet on dialysis are advised to reduce their protein intake to produce less waste products and relieve the kidneys.

Depending on the recommended level of protein reduction keto-analogues might be supplemented to the diet. Keto-analogues are precursors of amino acids and ensure that the body receives the right amount of amino acids for various functions (e.g., building up muscles) without causing additional waste products.

A low protein diet was used since the 1940s to slow progression of chronic kidney disease and can be supplemented with keto-analogues since the 1980s.
 

As high amounts of proteins can cause nitrogen waste products, keto-analogues should always be combined with a protein reduced diet. Keto-analogues function as a precursor for amino acids and are transformed in the body into the building blocks. Thereby, keto-analogues ensure that the body receives the right amount of amino acids for various functions (e.g. repair of tissue) without causing additional deleterious waste products.
 

Metabolic waste products derived from catabolising proteins have to be excreted via your kidneys. In chronic kidney disease patients, when the kidney function is impaired, they cannot be eliminated properly and can harm your body. As the waste products can be like poison for the body, patients who do not need to receive dialysis yet,  are advised to reduce their protein intake. Therefore, fewer wastes will be generated while consuming a protein-reduced diet, and the kidneys are relieved.
 

In general, it is recommended to eat low amounts of sodium (especially table salt), so you can use herbs to spice your meals. You should also limit the amounts of phosphate (to be found e.g. in seafood, cereals, chocolate, bean products etc.) and make sure to eat eough calories. Furthermore, patients in the pre-dialysis stage should eat low amounts of protein.
 

Since a protein-reduced diet is mainly a vegetarian diet, protein rich foods like meat, fish, eggs, cheese, milk/milk products are only allowed in very limited amounts. Please talk to your physician or dietitian to find out about your daily protein intake.
 

As this has to be decided upon your disease history and individual situation, please ask your physician or dietitian.