CDN Renal & Cardiac Nutrition 4 — Questions and Answers
Question 1: A renal dietitian assesses a patient's protein-energy wasting (PEW). Which combination of findings best confirms PEW in a dialysis patient?
- High BMI and high albumin
- Low serum albumin, unintentional weight loss, and reduced muscle mass (Correct answer)
- High BUN and high creatinine
- Low phosphorus and high potassium
Correct answer: Low serum albumin, unintentional weight loss, and reduced muscle mass
PEW is characterized by low serum albumin, involuntary weight loss, and muscle wasting, reflecting inadequate protein and energy stores in CKD.
Question 2: Which cooking method most effectively reduces the potassium content of vegetables for CKD patients?
- Steaming
- Microwaving
- Leaching (boiling in large amounts of water and discarding water) (Correct answer)
- Roasting at high temperature
Correct answer: Leaching (boiling in large amounts of water and discarding water)
Leaching by peeling, cutting small, soaking in water, then boiling and discarding the water can reduce vegetable potassium by 30-50%.
Question 3: A patient with cardiac cachexia needs nutritional support. What calorie target is most appropriate?
- 15-20 kcal/kg/day
- 25-35 kcal/kg/day (Correct answer)
- 45-50 kcal/kg/day
- 10 kcal/kg/day
Correct answer: 25-35 kcal/kg/day
Cardiac cachexia patients require 25-35 kcal/kg/day to support anabolism and prevent further catabolism without overloading cardiac function.
Question 4: What is the primary concern with using phosphorus-containing food additives in CKD patients compared to natural phosphorus in food?
- Additive phosphorus contains fewer calories
- Inorganic phosphorus additives are nearly 100% absorbed vs 40-60% of organic phosphorus (Correct answer)
- Natural phosphorus is absorbed more completely
- Additives contain aluminum which binds phosphorus
Correct answer: Inorganic phosphorus additives are nearly 100% absorbed vs 40-60% of organic phosphorus
Inorganic phosphate additives are almost completely absorbed intestinally, while organic phosphorus bound to proteins in natural foods is only 40-60% bioavailable.
Question 5: A patient with nephrotic syndrome presents with significant edema and low serum albumin. What protein recommendation is appropriate?
- Very high protein intake (2.5 g/kg) to replace lost albumin
- Normal protein intake (0.8-1.0 g/kg) as high protein increases proteinuria (Correct answer)
- No dietary protein allowed
- Protein restriction below 0.6 g/kg to preserve kidney function
Correct answer: Normal protein intake (0.8-1.0 g/kg) as high protein increases proteinuria
High protein intake worsens proteinuria in nephrotic syndrome; normal intake of 0.8-1.0 g/kg is recommended to avoid accelerating protein losses.
Question 6: Coenzyme Q10 supplementation has been studied in which cardiac condition for potential benefit?
- Atrial fibrillation
- Peripheral artery disease
- Heart failure (Correct answer)
- Aortic stenosis
Correct answer: Heart failure
CoQ10 has been studied in heart failure due to its role in mitochondrial energy production and antioxidant function, with some trials showing improved outcomes.
Question 7: When counseling a renal patient about hidden phosphorus in processed foods, which label term does NOT indicate a phosphorus additive?
- Phosphoric acid
- Calcium phosphate
- Ascorbic acid (Correct answer)
- Sodium polyphosphate
Correct answer: Ascorbic acid
Ascorbic acid is vitamin C, not a phosphorus-containing additive; the other options all contain phosphate that contributes to phosphorus load.
CDN Renal & Cardiac Nutrition 4
A renal dietitian assesses a patient's protein-energy wasting (PEW).
Which combination of findings best confirms PEW in a dialysis patient?