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Chapter 22: Chronic Renal Failure and the Uremic Syndrome: Nutritional Issues

What is the recommended dietary protein intake in stable nondialysis CKD patients with eGFR less than 45 mL/min?

A. 0.3–0.4 g/kg ideal body weight per day

B. 0.6–0.8 g/kg ideal body weight per day

C. 0.9–1.1 g/kg ideal body weight per day

D. 1.2–1.4 g/kg ideal body weight per day

E. >1.5 g/kg ideal body weight per day

The answer is B. A low-protein diet (LPD) is traditionally defined as 0.6–0.8 g/kg/day of daily protein intake; it is recommended to nondialysis dependent CKD patients with stage 3b to 4 CKD or any CKD stage and substantial proteinuria. LPD may slow CKD progression rate, mitigate uremic symptoms and ensure adequate protein intake, especially if at least 50% of it is high biologic value protein. The Institute of Medicine recommends 0.8 g/kg/day as the required daily protein intake, while 0.9–1.1 g/kg/day range is generally recommended by dietitians and other practitioners. The 1.2–1.4 g/kg/day is considered high-protein diet and usually recommended to prevalent dialysis patients on standard dialysis dose and frequency and minimal to no residual kidney function. Any protein intake >1.5 g/kg/day is considered very high protein intake, and it may be required for hypercatabolic states such as patients under critical care conditions.

All of the following agents can be used to stimulate appetite in dialysis patients except for

A. Megestrol acetate

B. Dronabinol

C. Mirtazapine

D. Dihydroxycholecalciferol

The answer is D. Megestrol acetate (Megace) is a steroidal progestin that has been used as an appetite stimulant in patients with cancer cachexia or AIDS and also occasionally in anorectic or malnourished dialysis patients. Dronabinol (Marinol) is a cannabinoid (similar to marijuana, which is herbal cannabis) and may be used to treat loss of appetite. Mirtazapine (Remeron, or under other brand names) is an antidepressant agent which may lead to substantial weight gain and which has been occasionally used as an appetite stimulant in dialysis patients. Dihydroxycholecalciferol (Calcitriol) is active vitamin D and is often administered for correction of secondary hyperparathyroidism, it has no known effect on improving appetite.

What is the recommended dietary protein intake for stable maintenance (thrice-weekly) hemodialysis patients without any residual kidney function?

A. 0.3–0.4 g/kg idea body weight per day

B. 0.6–0.8 g/kg idea body weight per day

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