In older adults with CKD who are on dialysis, protein needs are:

• A. Increased
• B. Decreased
• C. Unchanged
• D. Eliminated

Answer: (B)

Protein needs rise in older adults with CKD who are on dialysis because the dialysis process itself causes amino acid losses and creates a catabolic state. These losses mean the body must intake more protein to maintain nitrogen balance and preserve lean body mass, immune function, and overall health. In practice, adults on maintenance dialysis are typically advised to consume about 1.2–1.4 g of protein per kilogram of body weight per day (up to around 1.2–1.5 g/kg/day for peritoneal dialysis), with energy intake of roughly 30–35 kcal/kg/day to spare protein for tissue synthesis. This approach helps prevent protein-energy wasting, which is especially a concern in older adults. Lower or unchanged protein intake would not compensate for dialysis-related losses and could worsen malnutrition, while eliminating protein is not appropriate for someone on dialysis.