According to the complex pathophysiology, there are several methods and tools to treat or to influence the symptoms and metabolic consequences of CKD. Key points in CKD treatment include management of blood pressure, mineral metabolism, and blood glucose levels, as well as lifestyle modifications including an appropriate diet and physical activity. Main goal of CKD treatment is to postpone the start of dialysis and possibly to avoid initiation of renal replacement therapy (RRT). Protein-restricted diets with or without ketoanalogues (KA) supplementation are the mainstay of such nutritional interventions and recommended by the latest Kidney Disease Outcomes Quality Initiative (KDOQI) guideline on nutrition in CKD as a basic therapeutic approach. Their real impact, however, on the course of renal failure, kidney and patient-survival is difficult to demonstrate, because of patient compliance and methodological biases.