In older adults with CKD, when should more modest protein restriction be assessed?

• A. >80 years old or with malnutrition
• B. Always restrict protein to very low levels
• C. Only if dialysis is not available
• D. Never adjust protein restriction

Answer: (A)

Managing protein in older adults with CKD requires balancing kidney protection with preserving nutritional status. The best approach is to reassess and potentially use a more modest restriction when the patient is over about 80 years old or has signs of malnutrition, because advanced age and frailty increase the risk of protein-energy wasting if protein is restricted too aggressively. In these cases, a less restrictive plan helps maintain muscle mass and overall nutrition while still considering kidney function.

Restricting protein to very low levels for all older adults with CKD isn’t appropriate, as it can worsen malnutrition and frailty. Relying on dialysis status alone isn’t the sole determinant for adjusting restriction, since needs vary with nutritional status and CKD stage. And protein limits should be adjusted over time as the patient’s condition changes, not kept fixed forever.