Case Analysis & Practical Application Flashcards

A 58-year-old male on hemodialysis presents with serum potassium of 6.8 mEq/L after reporting he consumed a large amount of tomato sauce with pasta. Which dietary modification is the MOST urgent recommendation?

Answer: Limit tomato-based products and other high-potassium foods to reduce intake

Limiting high-potassium foods like tomato products is the primary dietary intervention for hyperkalemia management in dialysis patients.

A peritoneal dialysis patient with residual kidney function has a GFR of 8 mL/min. How should protein recommendations differ from a standard HD patient with no residual function?

Answer: Protein needs may be slightly lower since residual function provides additional clearance

Residual kidney function in PD patients contributes to overall solute clearance, which can modestly reduce the protein prescription compared to anuric PD patients.

A CKD Stage 4 patient (GFR 22 mL/min) has a serum bicarbonate of 18 mEq/L. Which dietary strategy can help address this metabolic acidosis?

Answer: Encourage consumption of fruits and vegetables to provide an alkaline ash load

Fruits and vegetables provide an alkaline dietary load that can help correct metabolic acidosis in CKD patients with adequate urine output.

During a nutrition assessment, a hemodialysis patient reports eating a protein supplement between sessions. Her nPCR is 1.4 g/kg/day but she has persistent hyperphosphatemia. What is the MOST likely issue?

Answer: Her high protein intake from supplements may be contributing to phosphorus load

High protein intakes, especially from supplements containing phosphorus additives, can worsen hyperphosphatemia even when phosphate binders are prescribed.

A renal dietitian evaluates a patient newly started on hemodialysis who was previously following a very low protein diet (0.6 g/kg) for CKD. What change in protein recommendation is warranted?

Answer: Increase protein to at least 1.2 g/kg/day to account for dialytic losses

Once hemodialysis begins, protein requirements increase to 1.2 g/kg/day or more to compensate for amino acid losses during dialysis sessions.

A 45-year-old female HD patient with diabetes reports a calorie intake of only 1,100 kcal/day and has lost 5 lbs over 2 months. Her SGA score indicates moderate malnutrition. What is the FIRST step in her nutrition intervention?

Answer: Conduct a thorough food history to identify barriers to adequate intake

A comprehensive food history is essential before selecting an intervention to identify the underlying cause of poor intake and tailor appropriate support.

A patient on hemodialysis presents with intradialytic hypotension during sessions and has been told to increase salt and fluid intake between treatments. How should the renal dietitian respond to this advice?

Answer: Evaluate the recommendation critically, as excess sodium/fluid can worsen interdialytic weight gain and hypertension

While some sodium may help maintain blood pressure, excess sodium drives thirst and fluid accumulation, increasing interdialytic weight gain and cardiovascular risk.