Risk Assessment & Mitigation Flashcards

A dietitian notes a hemodialysis patient has consistently low predialysis serum creatinine values despite stable dialysis adequacy (Kt/V ≥ 1.4). What nutritional risk does this most likely indicate?

Answer: Reduced muscle mass consistent with protein-energy wasting

Low serum creatinine in dialysis patients often reflects reduced muscle mass and inadequate protein intake rather than improved clearance, signaling protein-energy wasting risk.

Which risk factor most significantly increases the likelihood of developing oxalate nephropathy in patients who have had Roux-en-Y gastric bypass surgery?

Answer: Enteric hyperoxaluria from fat malabsorption

After gastric bypass, fat malabsorption causes unabsorbed fatty acids to bind calcium in the gut, leaving oxalate free to be absorbed and excreted in high concentrations by the kidneys.

A CKD patient is prescribed an ACE inhibitor and a potassium-sparing diuretic simultaneously. Which electrolyte risk requires urgent dietary counseling?

Answer: Life-threatening hyperkalemia from additive potassium retention

Both ACE inhibitors and potassium-sparing diuretics independently elevate serum potassium; their combination in CKD creates a high risk for dangerous hyperkalemia requiring immediate dietary potassium restriction.

During a nutrition-focused physical exam on a peritoneal dialysis patient, the dietitian observes temporal wasting, decreased grip strength, and loss of interosseous muscle. These findings collectively suggest which risk?

Answer: Severe protein-energy wasting requiring urgent intervention

Temporal muscle wasting, interosseous muscle loss, and reduced grip strength are clinical signs of severe protein-energy wasting that indicate high nutritional risk and mortality.

A CKD patient with diabetes develops an ABI (ankle-brachial index) of 0.7. Which nutritional intervention is most directly indicated to mitigate associated wound healing risk?

Answer: Adequate protein and calorie provision with micronutrient repletion

Peripheral artery disease (ABI <0.9) impairs tissue perfusion; adequate protein, calories, zinc, vitamin C, and vitamin A are critical nutritional supports for wound healing risk mitigation.

A renal dietitian reviews a CKD patient's dietary recall showing high intake of canned vegetables and processed meats. Beyond sodium and potassium, which specific hidden additive risk must be assessed?

Answer: Inorganic phosphorus additives with near-100% bioavailability

Processed foods commonly contain inorganic phosphate additives (polyphosphates) that are almost completely absorbed, unlike organic phosphorus in whole foods, dramatically increasing phosphorus load.

Which assessment finding in a new hemodialysis patient most strongly warrants referral for nutritional support beyond standard renal diet counseling?

Answer: Unintentional weight loss >5% in 3 months with albumin <3.5 g/dL

Significant unintentional weight loss combined with hypoalbuminemia meets criteria for severe protein-energy wasting and requires intensive nutritional intervention beyond standard counseling.