Which factors increase the risk of malnutrition in patients with CKD?

• A. Restrictive diets, anorexia, catabolic illness, malabsorptive disorders, nutrient loss from dialysis.
• B. Regular exercise and balanced meals.
• C. High-protein intake exclusively.
• D. Adequate vitamin supplementation.

Answer: (A)

In CKD, malnutrition risk rises when intake falls and the body’s needs are met less than they should be, while losses and catabolic processes accelerate nutrient depletion. Restrictive diets can unintentionally lower overall energy and protein intake because many foods are limited to meet kidney-specific targets, so even though the restrictions are intended to protect kidney function, they can contribute to undernutrition. Anorexia is common in uremia and during inflammation, reducing appetite and food intake further. Catabolic illnesses, infections, and stress increase protein breakdown, making it harder to maintain muscle and energy stores. Malabsorptive conditions—or problems that hinder nutrient absorption—lead to insufficient uptake of calories and micronutrients. Nutrient loss from dialysis directly removes amino acids, water-soluble vitamins, and other nutrients during each session, which, without compensatory intake, promotes protein-energy wasting.

The other options don’t fit as risk factors for malnutrition. Regular exercise and balanced meals help protect against malnutrition by preserving lean mass and ensuring adequate energy and nutrient intake. A high-protein intake used in isolation isn’t a risk factor for malnutrition; it’s more about balance and kidney function. Adequate vitamin supplementation helps prevent micronutrient deficiencies rather than contributing to malnutrition.