CSR Protein and Energy Requirements for Dialysis Patients 2

Question 1

A hemodialysis patient has been receiving ONS (oral nutritional supplements) for 3 months with no improvement in serum prealbumin (remains 12 mg/dL). What is the MOST appropriate next nutritional intervention?

Accepted Answer

Reassess for underlying causes (inflammation, inadequate dialysis, depression/anorexia), consider escalating to intradialytic parenteral nutrition (IDPN) or enteral tube feeding, and involve a multidisciplinary team

Answer

Failure to respond to ONS warrants systematic reassessment: rule out active inflammation (CRP elevation), inadequate dialysis dose, depression/anorexia, medication side effects, and malabsorption. Escalation to IDPN or enteral nutrition, with multidisciplinary involvement, is the appropriate next step.

Question 2

Renal-specific oral nutritional supplements (ONS) differ from standard formulas in what key nutritional characteristic?

Accepted Answer

They are calorically dense (1.8–2.0 kcal/mL), fluid-restricted, and have lower levels of potassium, phosphorus, and sometimes protein compared to standard formulas

Answer

Renal-specific formulas (Nepro, Novasource Renal) are calorie-dense (1.8–2.0 kcal/mL) to maximize energy in small volumes (fluid restriction), and are formulated with lower potassium, phosphorus, and sodium compared to standard high-protein supplements.

Question 3

The 'anabolic resistance' phenomenon in dialysis patients means that dietary protein has reduced effectiveness in stimulating muscle protein synthesis. What strategy BEST counteracts anabolic resistance?

Accepted Answer

Combining resistance exercise with evenly distributed adequate protein intake (≥25–30 g protein per meal), emphasizing leucine-rich sources

Answer

Anabolic resistance in dialysis patients is overcome by combining resistance exercise (most effective anabolic stimulus) with leucine-rich protein sources distributed across meals. Leucine activates mTOR-mediated muscle protein synthesis. ≥25–30 g protein per meal is the threshold for maximal stimulation in resistant muscle.

Question 4

According to the protein balance concept, a stable HD patient with nPCR (normalized protein catabolic rate) of 0.8 g/kg/day is BEST described as:

Accepted Answer

Having inadequate dietary protein intake, at risk for negative nitrogen balance and protein-energy wasting

Answer

In stable HD patients, nPCR approximates dietary protein intake. nPCR of 0.8 g/kg/day falls below the KDOQI recommendation of ≥ 1.2 g/kg/day, indicating inadequate protein intake and risk for negative nitrogen balance and PEW.

Question 5

A 28-year-old female dialysis patient is pregnant. How do protein and energy requirements change during pregnancy in the dialysis setting?

Accepted Answer

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

Answer

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.

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR Protein and Energy Requirements for Dialysis Patients 2