Objective To investigated the effects of long term use of very low protein diet(VLPD,0 3 g?kg-1?d-1) treatment on patients with chronic renal insufficiency without essential amino acids(EAAs) or related ketoacids supplement.Methods Thirty seven patients with established severe chronic renal failure (CRF)[Scr(588 2?123 5)?mol/L, Ccr(9 77?3 48)ml?min-1?(1 73m2)-1]were divided into 2 groups according to their actual protein intake: 20 patients with protein intake of (0 33?0 04)g?kg-1?d-1 were used as VLPD group, while other 17 CRF patients whose protein intake was 0 6 g?kg-1?d-1 were served as low protein diet group (LPD). Results All patients in VLPD group showed good compliance to this very low protein diet,and no one presented signs of protein malnutrition during the observation. The concentrations of serum albumin and transferrin were maintained in normal ranges during the follow up period despite the transferrin levels in both groups gradually decreased as time went on. The serum concentration of transferrin was higher in VLPD patients than that in LPD patients at the end of study (P