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Protein-energy wasting on dialysis — ESENeph MCQ

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ModerateNutrition in Kidney DiseaseProtein-energy wasting on dialysisESENeph

A 66-year-old man on haemodialysis has poor appetite and unintentional weight loss. Albumin is 28 g/L, CRP is normal and dietary review shows low protein intake because he avoids phosphate. Phosphate is 1.1 mmol/L and potassium is 4.6 mmol/L. What is the most appropriate management?

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Correct answer: C — Renal dietitian review to improve protein-energy intake

Protein-energy wasting in dialysis requires dietetic assessment and adequate protein-energy intake; excessive dietary restriction can worsen malnutrition. Escalating phosphate binders is not the priority with normal phosphate and low intake. Stopping dialysis would not address nutritional deficiency and could worsen uraemia. The pearl is that dialysis patients often need higher protein intake than non-dialysis CKD patients.

Reference: UKKA Nutrition in CKD Guideline; UKKA Haemodialysis Guideline