CDN Renal & Cardiac Nutrition 3 — Questions and Answers
Question 1: A patient with end-stage renal disease on peritoneal dialysis absorbs glucose from dialysate. What nutritional adjustment is necessary?
- Increase carbohydrate intake to compensate
- Reduce total caloric intake to account for dialysate glucose absorption (Correct answer)
- Increase protein intake to 2 g/kg/day
- Restrict all dietary fat
Correct answer: Reduce total caloric intake to account for dialysate glucose absorption
Peritoneal dialysis patients absorb 300-800 kcal/day from dialysate glucose, requiring downward adjustment of dietary calorie intake.
Question 2: Which omega-3 fatty acid is most effective at reducing serum triglycerides in cardiac patients?
- ALA (alpha-linolenic acid)
- EPA (eicosapentaenoic acid) (Correct answer)
- LA (linoleic acid)
- GLA (gamma-linolenic acid)
Correct answer: EPA (eicosapentaenoic acid)
EPA and DHA, particularly EPA, are the most potent omega-3s for triglyceride reduction, with ALA having minimal direct effect.
Question 3: A patient with chronic kidney disease develops metabolic acidosis. What dietary intervention helps buffer acid load?
- Increase dietary protein
- Increase fruit and vegetable intake (with potassium monitoring) (Correct answer)
- Restrict phosphorus further
- Reduce water intake
Correct answer: Increase fruit and vegetable intake (with potassium monitoring)
Fruits and vegetables provide bicarbonate precursors that buffer metabolic acidosis in CKD, though potassium must be monitored carefully.
Question 4: What is the recommended fluid restriction for a stable hemodialysis patient to limit interdialytic weight gain?
- No restriction needed
- 500-750 mL/day
- Urine output plus 750-1000 mL/day (Correct answer)
- 3 liters/day
Correct answer: Urine output plus 750-1000 mL/day
Fluid allowance for dialysis patients is typically residual urine output plus 750-1000 mL/day to prevent excessive interdialytic weight gain.
Question 5: Which dietary pattern is most strongly supported by evidence for secondary prevention of myocardial infarction?
- Ketogenic diet
- Mediterranean diet (Correct answer)
- Low-FODMAP diet
- BRAT diet
Correct answer: Mediterranean diet
The Mediterranean diet, rich in olive oil, fish, legumes, and vegetables, has the strongest evidence for reducing recurrent cardiovascular events.
Question 6: A CKD patient's laboratory shows elevated serum potassium of 6.1 mEq/L. Which food group should be most aggressively restricted?
- Refined grains and white bread
- High-potassium fruits and vegetables like bananas, oranges, and potatoes (Correct answer)
- Low-fat dairy products
- Lean meats and poultry
Correct answer: High-potassium fruits and vegetables like bananas, oranges, and potatoes
High-potassium fruits and vegetables are the primary dietary source driving hyperkalemia and must be restricted or replaced in CKD.
Question 7: In heart failure management, what is the standard sodium restriction guideline for symptomatic patients?
- No restriction required
- Less than 4,000 mg/day
- Less than 2,000-3,000 mg/day (Correct answer)
- Less than 500 mg/day
Correct answer: Less than 2,000-3,000 mg/day
ACC/AHA guidelines recommend sodium restriction to <2,000-3,000 mg/day in symptomatic heart failure to reduce fluid retention.
CDN Renal & Cardiac Nutrition 3
A patient with end-stage renal disease on peritoneal dialysis absorbs glucose from dialysate.
What nutritional adjustment is necessary?