Inclusion Criteria:  advanced CKD not yet on renal replacement therapy (10< - eGFRcreat <30 ml/min) age >65 years at risk of malnutrition at Malnutrition Inflammation Score (4≤MIS≤7) spontaneous low protein-energy intake (proteins < 0.8g/kg and energy < 25 kcal/kg).  Exclusion Criteria:  Active chronic infectious diseases Heart failure of severity > NYHA2 Active neoplastic diseases Inability to cooperate Presumed overall life expectancy < 6 month Decompensated liver diseases Malabsorption Decompensated thyroid o surrenal diseases Refusal to participate Immunosuppressive and/or steroid therapy