Which energy intake level induces neutral nitrogen balance in maintenance hemodialysis patients?

• A. 25 kcal/kg
• B. 30 kcal/kg
• C. 40 kcal/kg
• D. 35 kcal/kg

Answer: (D)

Neutral nitrogen balance in maintenance hemodialysis patients hinges on providing enough daily calories to spare amino acids from being used for energy. When energy intake is sufficient, dietary protein can be directed toward tissue maintenance rather than energy production, helping balance nitrogen losses from dialysis. The commonly targeted energy level to achieve this balance is about 35 kcal per kilogram of body weight per day. If energy is too low, the body catabolizes protein to meet energy needs, increasing nitrogen losses and leading to negative nitrogen balance. If energy intake is higher than needed, there isn’t a further nitrogen balance benefit and excess calories can contribute to unwanted weight gain. Therefore, 35 kcal/kg/day is the best target to achieve neutral nitrogen balance in this context.