CSR CKD Stages and Dietary Management 2

Question 1

A patient transitions from CKD Stage 4 to initiating hemodialysis. Which of the following dietary changes is CORRECT during this transition?

Accepted Answer

Protein intake should increase from 0.6–0.8 g/kg/day to ≥1.2 g/kg/day

Answer

Upon initiating HD, protein requirements increase significantly (to ≥1.2 g/kg/day) because dialysis removes amino acids and increases whole-body protein catabolism. Sodium and potassium restrictions typically continue or intensify with HD.

Question 2

In CKD, which marker is used to assess dietary protein intake (DPI) adequacy and is derived from urea generation kinetics?

Accepted Answer

Normalized protein catabolic rate (nPCR) / protein equivalent of nitrogen appearance (PNA)

Answer

Normalized protein catabolic rate (nPCR), also known as normalized protein nitrogen appearance (nPNA), is calculated from urea generation rate (from pre- and post-dialysis BUN and interdialytic weight changes) and normalized to body weight, reflecting dietary protein intake in steady-state patients.

Question 3

For a CKD Stage 5 (non-dialysis) patient with GFR 12 mL/min who has decided to pursue conservative management (no dialysis), what is the recommended dietary protein intake?

Accepted Answer

0.6–0.8 g/kg/day, or 0.3–0.4 g/kg/day with essential amino acid/keto-acid supplementation

Answer

For conservative (non-dialysis) management of CKD Stage 5, KDOQI recommends 0.6–0.8 g/kg/day (or very-low-protein diet 0.3–0.4 g/kg/day with keto-acid analogs) to minimize uremia while preserving nutritional status and delaying progression.

Question 4

A dietitian is counseling a CKD Stage 3a patient about the 'DASH diet.' Which modification is necessary to make DASH appropriate for early CKD?

Accepted Answer

Modify the DASH diet by limiting potassium-rich foods and reducing dairy (higher phosphorus) in patients with hyperkalemia or hyperphosphatemia

Answer

The standard DASH diet is high in potassium (4700 mg/day target) and phosphorus from dairy, which may be problematic in CKD with hyperkalemia or hyperphosphatemia. Individualized modifications restricting potassium-dense foods and dairy portions make DASH CKD-appropriate.

Question 5

What is the primary goal of dietary sodium restriction in CKD, and what is the current guideline-recommended target?

Accepted Answer

Reduce blood pressure, proteinuria, and fluid retention; target < 2.3 g/day (100 mEq/day) of sodium

Answer

Sodium restriction reduces systemic blood pressure (via volume reduction), decreases glomerular hyperfiltration and proteinuria, and prevents fluid retention. KDOQI 2020 and KDIGO recommend < 2.3 g sodium/day (< 5.8 g salt/day or < 100 mEq/day) for all CKD patients.

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR CKD Stages and Dietary Management 2