The CSR credential — Board Certified Specialist in Renal Nutrition — is awarded by the Commission on Dietetic Registration (CDR) to registered dietitians who demonstrate advanced expertise in kidney disease nutrition. The exam spans the full continuum of renal care: CKD staging and progression, hemodialysis and peritoneal dialysis nutrition protocols, acute kidney injury management, renal transplant dietary modifications, and the complex electrolyte and fluid restrictions unique to patients with impaired kidney function.
Our free CSR practice test PDF is printable, portable, and covers all major exam domains — from biochemical marker interpretation to phosphate binder selection, potassium restriction strategies, and protein-energy wasting assessment. Download and study on your own schedule.
The CSR exam requires strong knowledge of GFR-based CKD staging (Stages 1 through 5, including Stage 5D for dialysis patients), eGFR calculation methods, CKD progression markers, and albuminuria grading. Candidates must understand CKD-related complications including anemia of chronic kidney disease, mineral and bone disorder (CKD-MBD), cardiovascular disease risk in CKD patients, and metabolic acidosis management through dietary and pharmacological interventions.
Assessment in CKD is uniquely challenging due to fluid shifts, edema, amputations, and the obesity paradox in dialysis populations. Exam questions cover Subjective Global Assessment (SGA) adapted for dialysis, the Malnutrition Inflammation Score (MIS), and the limitations of standard markers like albumin and prealbumin in the presence of inflammation. Candidates must interpret serum creatinine, BUN, phosphorus, potassium, calcium, and bicarbonate values in clinical context.
Protein requirements differ by treatment modality: 0.6 to 0.8 g/kg/day for non-dialysis CKD stages 3 through 5, 1.2 g/kg/day for hemodialysis patients, and 1.2 to 1.3 g/kg/day for peritoneal dialysis patients due to increased losses. Energy recommendations are generally 30 to 35 kcal/kg/day. Micronutrient management questions focus on phosphorus restriction strategies, phosphate binder selection (calcium carbonate, sevelamer, lanthanum carbonate, ferric citrate), potassium restriction with leaching techniques, sodium control for fluid balance and hypertension, and the clinical distinction between inactive and active vitamin D forms including calcitriol prescription thresholds in CKD.
The CSR exam tests knowledge of both hemodialysis (3x weekly, IDPN support) and peritoneal dialysis (CAPD vs. CCPD, glucose absorption from dialysate, elevated protein losses). For acute kidney injury, candidates must know KDIGO AKI staging, protein recommendations during AKI, enteral vs. parenteral nutrition route selection, and electrolyte management during renal recovery. Renal transplant nutrition covers immunosuppressant side effects on nutritional status, post-transplant dietary modifications, and food safety protocols for immunocompromised patients.
Complement this printable PDF with our interactive CSR practice test online, where you can answer questions with immediate feedback, review detailed explanations for each answer, and track your performance across the major renal nutrition domains before your exam date.
Try these questions from our free Board Certified Specialist in Renal Nutrition practice tests. The correct answer and an explanation follow each question.
A 28-year-old female dialysis patient is pregnant. How do protein and energy requirements change during pregnancy in the dialysis setting?
Answer: B. Protein increases to 1.5–1.8 g/kg/day and energy to 35–40 kcal/kg/day; intensive daily dialysis (≥36 hours/week) is recommended to reduce uremic toxin exposure to the fetus
Pregnancy on dialysis requires significantly increased protein (1.5–1.8 g/kg/day, adding ~20 g/day for fetal growth), higher energy intake (35–40 kcal/kg/day), intensive daily dialysis (36+ hours/week to reduce BUN < 50 mg/dL to minimize fetal uremia), and careful monitoring of all micronutrients.
What is the recommended minimum energy intake for a hospitalized hemodialysis patient with an acute infection (higher catabolism)?
Answer: B. 30–35 kcal/kg IBW/day, potentially increasing to 35–40 kcal/kg during acute illness
KDOQI recommends 30–35 kcal/kg IBW/day for stable HD patients. During acute illness/stress, energy needs increase to 35–40 kcal/kg/day to overcome catabolism, preserve muscle mass, and support immune function.
A hemodialysis patient's normalized protein catabolic rate (nPCR) drops from 1.1 to 0.7 g/kg/day over 3 months. What nutritional risk does this trend indicate?
Answer: B. Protein-energy wasting and inadequate dietary intake
A declining nPCR below 1.0 g/kg/day in hemodialysis patients signals inadequate protein intake and is a marker of protein-energy wasting risk.
A CKD patient taking calcium carbonate as a phosphate binder is found to have hypercalcemia. What dietary counseling change is most appropriate?
Answer: B. Limit calcium-rich foods and discuss non-calcium binder alternatives with the care team
Hypercalcemia in a patient on calcium-based binders warrants limiting high-calcium foods and flagging the need for non-calcium binder consideration.
Take the full Board Certified Specialist in Renal Nutrition practice test