Abstract: Objective：To explore the effects of optimal nutritional guidance based on chronic kidney disease (CKD) integrative outpatient service in improving adherence to low protein diet and the nutritional status of nondialysis CKD patients. Methods：The 196 stage 3B to 4 CKD patients were randomly assigned to the optimizednutrition group and the traditional group. All participants received dietary counseling aimed at achieving a daily protein intake of 0.6 g/kg and a daily energy intake of 3035 kcal/kg by two different modes of nutrition management. By using MDRD to calculate the eGFR, the nutritional status including human body measurement, biochemical indexes and subjective global nutritional assessment (SGA) were assessed every three months in oneyear followup. Results：There was no significant difference in change of the eGFR between the two groups. Compared with the traditional group, the optimizednutrition group had better low protein diet adherence, lower dietary protein intake, higher dietary calorie, higher serum albumin level and weight, lower serum urea nitrogen and parathyroid hormone, and the nutritional status assessed by SGA improved significantly (P<0.05). Conclusions：The optimal nutritional guidance is effective in increasing patient adherence, improving the nutrition status and with good safety.