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Background: Several clinical studies have shown that a low protein diet in patients with Chronic Kidney Disease (CKD), delays and prevents the natural progression of the end stage renal disease (ESRD) and the necessary treatment of renal dialysis. Studies to investigate the effects of the low protein diets in preventing severe kidney failure are few for Italy. The aim of this study is to estimate the cost-effectiveness of a low protein diet treatment compared with no dietary treatment in patients with CKD 4-5 after 2, 3, 5 and 10 years. Methods: A Markov model simulating was developed to estimate costs and QALYs associated with low protein treatment and no treatment for patients with CKD 4-5. The prevalence of patients with CKD 4-5 refers to a population aged ≥40 years old was 0.3% estimated by a study of Gambaro et al. on the 2010. The transition probability was estimated on data from seven studies identified by a Cochrane review to determine the efficacy of low protein diets in delaying the need to start maintenance dialysis. The Quality Adjusted Life Years (QALYs) scores used were estimated with the Time Trade Off by a study of Gorodetskaya et al. in 2005. The costs of dialysis have been estimated by a study of Censis (2009) and amounted to approximately €34,071.7 per patient per year. The costs of a low