CSR Protein and Energy Requirements for Dialysis Patients

Question 1

A stable patient on peritoneal dialysis weighs 65 kg (IBW 62 kg). According to KDOQI 2020, what is the minimum daily protein intake recommendation?

Accepted Answer

1.2–1.3 g/kg IBW/day = 74–81 g/day

Answer

KDOQI 2020 recommends ≥ 1.2–1.3 g/kg IBW/day for stable PD patients (higher than HD due to peritoneal protein losses of 5–15 g/day). Using IBW of 62 kg: 62 × 1.2 = 74.4 g/day minimum.

Question 2

Which amino acid is classified as 'conditionally essential' and particularly important to supplement in dialysis patients due to its accelerated utilization and depletion?

Accepted Answer

Glutamine

Answer

Glutamine is the most abundant amino acid in plasma and muscle. During the catabolic stress of dialysis, glutamine consumption increases markedly (fuel for enterocytes, immune cells), and endogenous synthesis may not meet demand, making supplementation beneficial in some dialysis patients.

Question 3

What is the recommended minimum energy intake for a hospitalized hemodialysis patient with an acute infection (higher catabolism)?

Accepted Answer

30–35 kcal/kg IBW/day, potentially increasing to 35–40 kcal/kg during acute illness

Answer

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.

Question 4

A hemodialysis patient has a body weight of 75 kg but has significant edema (+5 kg estimated). What should the dietitian use to calculate protein and energy requirements?

Accepted Answer

Estimated dry weight (approximately 70 kg after removing estimated edema) or IBW, whichever is appropriate

Answer

Edematous weight does not reflect metabolically active tissue. Nutritional requirements should be based on estimated dry weight (actual weight minus estimated edema weight) or IBW to avoid overestimating protein and energy needs.

Question 5

Intradialytic parenteral nutrition (IDPN) is sometimes used to supplement nutrition in HD patients. What is the PRIMARY indication for IDPN?

Accepted Answer

IDPN is indicated when oral intake is inadequate and oral nutritional supplements have failed to achieve targets, particularly in patients with moderate-to-severe protein-energy wasting who cannot tolerate enteral nutrition

Answer

IDPN is a specialized form of parenteral nutrition infused during the HD session. It is indicated as a supplement when oral intake plus ONS cannot meet protein/energy targets, particularly in patients with moderate-to-severe PEW who cannot tolerate or refuse enteral nutrition.

(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