CKD treatment options

Treatment of chronic kidney disease (CKD) varies according to the severity. However, steps can be taken in all cases to: control hypertension, correct salt and water imbalance, treat urinary tract infections, and reduce risk of heart and blood vessel diseases. Most people with CKD will be able to slow down progression through regular check-ups and medication intake.

Renal replacement therapy (RRT)

In stage 5 (end-stage), most patients cannot survive without renal replacement therapy, such as dialysis or kidney transplantation.

Dialysis (haemodialysis & peritoneal dialysis)

In dialysis, waste is washed out and water is withdrawn from the blood. The two most widely used dialysis techniques in CKD are haemodialysis and peritoneal dialysis. Dialysis involves the removal of urea, and stabilisation of water and electrolyte levels in the blood via a dialysis machine.

This treatment option affects a patient’s quality of life, as they must be connected to the dialysis machine 3 times a week for 5 hours (haemodialysis) or exchange bags every 4-6 hours per day (peritoneal dialysis).

Kidney transplant

With a kidney transplantation, the transplanted organ takes over the role of the previous damaged kidneys. For a variety of reasons (not enough organ donors, health of the recipient etc.) many patients cannot be treated with kidney transplantation. Furthermore, several side effects can occur, such as a chronic defence reaction of the body´s immune system, as a result of the transplanted organ.

As dialysis is also connected to several restrictions in everyday life, read more about conservative treatment options to delay the start of dialysis.

Conservative treatment in the CKD predialysis phase

A comprehensive conservative treatment of chronic kidney disease (CKD) without dialysis uses dietary interventions and medications from earlier stages of the disease until start of dialysis. Most people with CKD will be able to control their condition with medication and regular check-ups.

The conservative, non-invasive treatment aims to

  • slow the disease‘s progression and thereby postpone the onset of renal replacement therapy (e.g., dialysis, transplantation)
  • avoid or attenuate the development of secondary diseases (e.g., bone disease, cardiovascular disease)

Conservative treatments of CKD include a broad spectrum of measures. Click on following link to get an overview of different conservative treatment options.

A dietary approach, in particular the restriction of protein intake (low protein diet) is an additional option. The effect of a low protein diet can be maximised by the supplementation of keto acids. This is an important pillar in pre-dialysis management and clinical studies have shown that the start of dialysis can be postponed.

How to postpone dialysis with keto acids

Suitable for many patients suffering from chronic kidney disease (CKD) of stages 4 and 5 is a low protein diet supplemented with keto acids, a treatment option to delay dialysis.

Protein in CKD

Proteins are important for various functions in your body including build-up of muscles and reactions of the immune system. Eating the right amount of protein is therefore especially important for sufferers of CKD. Over-consumption of protein, when your kidneys are weak, will lead to a build-up of waste in your body. This build-up can have harmful consequences such as: nausea, weakness, tiredness, shortness of breath and reduced appetite.

Read more about nutritional management in CKD and other ingredients (foods good for kidneys) you should consider when planning your diet.

Keto acids supplemented low protein diet

Keto acids, are nitrogen-free precursors of essential amino acids. Keto acids are converted to the respective amino acids in the body. In this way, no additional nitrogen intake occurs and the formation of nitrogen-containing waste products is reduced.

It is important to mention that keto acids do not work on their own. Keto acids are essential supplements to a protein restricted diet. Find out more about the nutritional management as well as specific diet recipes in chronic kidney disease.

Benefits of keto acid supplementation

Early treatment of advanced CKD patients with keto acids may delay the start of dialysis. Keto acid supplementation is are a safe and effective way for patients on a protein restricted diet (very low protein diet means 0.3 g/kg body weight/day) to ensure a sufficient daily intake of essential amino acids. 

Keto acids provide additional advantages such as:

  • Prevention of malnutrition
  • Improvement of metabolic disturbances typically found in CKD patients (e.g. reduction of blood urea and improvement of calcium-phosphate metabolism)
  • Reduction of proteinuria (phaenomenon of excessively excreted proteins in the urine)
  • Delay of dialysis for almost 1 year (10 months)1


1 Brunori G, Viola BF, Parrinello G et al. Efficacy and safety of a very-low-protein diet when postponing dialysis in the elderly: a prospective randomized multicenter controlled study. Am J Kidney Dis 2007;49:569-580.

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