NUTRITION

Estimation of nutritional intake

Dietitians can estimate intake via 24-h recall or diaries to compare against the guideline targets for protein, energy, and electrolytes, identifying gaps for personalized medical nutrition therapy in hemodialysis patients with protein energy wasting (PEW) or risk of PEW (Ikizler et al., 2020, Fiaccadori et al., 2021)

Protein intake

For metabolically stable hemodialysis patients, the target for protein is 1.0–1.2 g/kg/day ideal body weight.

Energy intake

Prescribe 25–35 kcal/kg/day (higher end for undernourished), adjusted for age/activity; KDOQI 2020 emphasizes energy adequacy to spare protein and improve outcomes in CKD stages 3–5D

Potassium and Phosphate

Individualize to serum levels (potassium 2–4 g/day, phosphate 800–1000 mg/day), prioritizing nutrient-dense foods, leaching, and binders over restriction; aligns with KDOQI 2020 electrolytes (Ikizler et al., 2020)guidance and KDIGO CKD-MBD [(2017)

Fluids

Tailor to urine output +500–1000 mL/day (IDWG <3–5% dry weight); KDOQI 2020/HD guidelines stress thirst counseling to balance hydration, BP, and sessions. Salt intake must also be considered when supporting patients with fluid restrictions.