Why is 30-35 kcal/kg/day considered acceptable for older adults on dialysis?

• A. Because older adults tend to be sedentary
• B. Because 40 kcal/kg would prevent weight gain
• C. Because 25 kcal/kg is insufficient
• D. Because 35 kcal/kg/day induces neutral nitrogen balance

Answer: (A)

The key idea is that energy needs in older adults on dialysis are often lower because activity levels tend to be reduced with age. A moderate target of 30-35 kcal per kg per day provides enough energy to spare protein for muscle and other tissues without promoting excess fat gain. Pushing intake higher, like 40 kcal/kg, increases the risk of weight gain and metabolic strain; going lower, around 25 kcal/kg, may be insufficient to maintain lean tissue under the catabolic stress of dialysis. While nitrogen balance is influenced by both energy and protein, merely aiming for a specific energy number doesn’t guarantee neutral nitrogen balance. So the main reason this range is acceptable is that older adults tend to be sedentary, making a moderate energy intake appropriate.