The use of ketoanalogues (KAs) with a very low-protein diet (VLPD) as a progressive approach to delay the progression of chronic kidney disease (CKD) has been appealing for decades (more than 40 years!), although cost-inhibitive, and in addition, KAs have not been readily available, at least in the United States, until recently. The updated Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline for Nutrition in CKD, published in 2020, has increased a renewed focus on the use of KAs, also often referred to as ketoacid analogues, in the conservative management of the VLPD in delaying the progression of kidney disease to end-stage kidney disease.