1. Protein and calories 1.1 Protein intake in patients with diabetic nephropathy The adaptive response of the human body to restriction of dietary protein intake includes inhibition of the oxidation of essential amino acids and reduction of postprandial whole-body protein degradation, and Brodsky et al. have shown that patients with diabetic nephropathy who appropriately restrict their dietary protein intake are not at a higher risk of malnutrition than the normal population, and so there is no need to worry about an increased incidence of malnutrition after restricting their diet. There is no need to worry about an increased incidence of malnutrition with dietary restriction. 1.2 Protein intake for chronic dialysis patients The incidence of malnutrition in chronic dialysis patients varies, Kopple reported that the incidence of malnutrition is 33% for mild to moderate, and 6%-8% for severe. According to the American Dialysis Association, the nutritional status of hemodialysis patients is significantly related to the adequacy of dialysis. Because hemodialysis loses 10-30g of amino acids each time, and peritoneal dialysis loses 4-6g of amino acids per day, the protein intake (DPI) of chronic hemodialysis patients is 1.2g/(kg・d), and the DPI of chronic peritoneal dialysis patients is 1.2-1.3g/(kg・d), of which 50% of the proteins are biologically high-value proteins; the energy intake of chronic hemodialysis and peritoneal dialysis patients is 146.3kJ/kg (35kcal/kg) (<60 years old) and 125.4~146.3kJ/kg (30~35kcal/kg) (>60 years old), and it should be higher when combined with infection, trauma, burns, about 188.28kJ/kg (45kcal/kg). Yu Yusheng found that the levels of albumin, prealbumin and transferrin increased significantly after amino acid dialysis solution treatment and the mental and dietary status of the patients was better than that of the conventional dialysis control group. Therefore, protein loss can be reduced by choosing amino acid dialysis solution and adequate dialysis. Generally speaking, fat accounts for about 30% of the total calories, protein accounts for less than 10%, and the rest of the calories will be supplied by carbohydrate oxidation, and patients with diabetic nephropathy have to limit the amount of carbohydrates, so they can only give enough carbohydrates while injecting insulin to control the blood glucose. 2, close monitoring of patient compliance and various nutritional indicators from monitoring the patient’s food calories and protein intake to understand the patient’s dietary compliance, calories should be calculated by accurately recording the 3-day recipes, and protein intake should be determined by the patient’s 24h urinary urea nitrogen content, and then according to the formula, i.e.: Protein intake = 6.25 × (24h urinary urea nitrogen +0.031 × body weight) g/d, body weight unit is kg. The nutritional status of patients mainly relies on the following indicators to determine: anthropometric measurements, such as body mass index, muscle circumference of the upper arm and skin fold thickness of the triceps area; biochemical tests, such as serum albumin, transferrin, prealbumin and insulin-like growth factor; subjective comprehensive nutritional assessment, based on the patient’s diet, symptoms, signs and functional examination results of the integrated assessment [4]. 3.Mechanism of α-keto acid to improve the nutritional status of CKD patients A mixture of α-keto acid (keto-leucine, keto-isoleucine, keto-phenylalanine, and keto-valine), α-hydroxy acid (hydroxy-methionine), and amino acids (lysine, threonine, tryptophan, histidine, and tyrosine) was added to DD Kaito. The mechanism of α-keto acid to improve the nutritional status of CKD patients may be: the use of urea nitrogen in the body to synthesize essential amino acids, while each tablet contains a combination of α-keto acid and α-keto acid to improve the nutritional status of patients. Synthesis of essential amino acids, at the same time, each tablet contains 50mg of calcium, which is conducive to the correction of calcium and phosphorus metabolism disorders; increase renal tubular reabsorption of branched-chain amino acids and serum protein, and increase blood concentration. In addition to providing 10 kinds of amino acids which are often lacking in patients with renal insufficiency and guaranteeing the nutrition of patients, Kaito also has the following advantages compared with the direct supply of essential amino acids: α-keto acid and α-hydroxy acid in Kaito’s composition are ingested into the body, which can combine with nitrogen to generate the corresponding amino acids under the action of aminotransferase and can reduce urea nitrogen in the body; it doesn’t dilate the glomerular entry artery, so it won’t increase the intraglomerular urea nitrogen in the glomerular. “Three highs”; in the form of calcium salts, while also supplementing calcium, is conducive to improving hyperphosphatemia and secondary hyperparathyroidism. 4, the precautions of diet Diet Try to eat food containing high calories and relatively low protein, such as potatoes, white potatoes, yams, pumpkin, etc. In addition, try to limit the intake of vegetable protein in the main food, and improve the proportion of high-quality protein, such as eggs, milk, lean meat and so on. The supply of inorganic salt should be adjusted in time with the changes of the condition, and salt intake should be appropriately limited when edema and hypertension occur. When the blood potassium is elevated and the urine output is reduced (less than 1,000 ml/d), it is required to appropriately limit the consumption of foods with high potassium content; for example, all kinds of dried foods (purple cabbage, mushrooms, dried jujubes, lilies, etc.), many kinds of vegetables (cauliflower, rape, etc.), all kinds of meats, potatoes, coarse grains, and so on. When blood potassium decreases or urine output increases, potassium should be supplemented accordingly. In the azotemia period should be given low phosphorus diet, not more than 600mg per day and low magnesium diet, daily intake of about 200mg is appropriate, at the same time should be supplemented with iron and vitamins. 5, Summary Chronic renal insufficiency patients glomerular filtration rate decreased, resulting in the accumulation of toxic metabolites in the body, which causes anorexia and digestive dysfunction, large amounts of proteinuria, a variety of metabolic processes in the body dysfunction, the implementation of a restrictive low-protein diet and the loss of nutrients in the process of dialysis and dialysis is not sufficient, resulting in a high incidence of malnutrition.