CSR Case Analysis & Practical Application 2

Question 1

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?

Accepted Answer

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

Answer

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

Question 2

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?

Accepted Answer

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

Answer

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

Question 3

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?

Accepted Answer

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

Answer

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

Question 4

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?

Accepted Answer

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

Answer

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

Question 5

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?

Accepted Answer

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

Answer

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

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR Case Analysis & Practical Application 2