By Stacey Phillips, MS, RDN
Having a tough time remembering all the calculations for different patient populations or disease states? Look no further. Here’s your cheat sheet for every situation.
Note: These are general recommendations. Use your clinical judgment to adjust for each patient’s individual needs. Use standard fluid calculations, unless otherwise specified.
Abbreviations: REE (resting energy expenditure); EER (estimated energy requirement)
Acute kidney injury (AKI)
Calories: 20 to 30 kcal/kg (100% to 130% REE)
- 0.8 to 1 g/kg if not receiving dialysis, non-catabolic
- 1 to 1.5 g/kg if receiving dialysis
- Up to 1.7 g/kg CRRT and/or hypermetabolic
*Avoid protein restriction with AKI to prevent/delay dialysis; maximum 2.5 g/kg with dialysis
- Restrict fluid with anuria or oliguria
- No fluid restriction with continuous renal replacement therapy (CRRT)
First 6 months = EER + 500 – 170 (milk energy output – weight loss)
Second 6 months = EER + 400 – 0 (milk energy output – weight loss)
Protein: 1.3 g/kg
Calories: indirect calorimetry, if available
Protein: 1.5 to 2 g/kg
Fluid: Parkland formula; urine output goal 0.3 to 0.5 ml/kg/hr for adults
Chronic kidney disease
Stage 3 to 5D, hemodialysis, peritoneal dialysis: 25 to 35 kcal/kg
Stage 3 to 5:
- Very low protein diet + keto acid analogs: 0.28 to 0.43 g/kg
- Low protein diet non-DM: 0.55 to 0.6 g/kg
- Low protein diet with DM: 0.6 to 0.8 g/kg
Stage 5D, hemodialysis and peritoneal dialysis (with/without diabetes): 1.0 to 1.2 g/kg
*Adjust protein provision based on metabolic stability
Stage 1 to 4: individualized based on comorbidities, physical findings, and alterations in urine output
Stage 5D, hemodialysis: urine output + 1,000 to 1,200 ml
Stage 5D, peritoneal dialysis: maintain fluid balance
BMI <30 kg/m2: 25 to 30 kcal/kg
BMI 30 to 50 kg/m2: 11 to 14 kcal/kg of actual weight
BMI >50 kg/m2: 22 to 25 kcal/kg of ideal weight
BMI <30 kg/m2: 1.2 to 2 g/kg
BMI 30 to 40 kg/m2: 2 g/kg of ideal weight
BMI >40 kg/m2: 2.5 g/kg of ideal weight
Calories: Harris-Benedict equation, if indirect calorimetry is unavailable
Protein: 1.5 to 1.8 g/kg, if wasting syndrome is present
Liver disease (end-stage, cirrhosis, hepatic encephalopathy)
Calories: indirect calorimetry, if available or REE x 1.2 to 1.4
Protein: 1 to 1.5 g/kg
Calories: indirect calorimetry if available, 25 kcal/kg
Protein: 1.5 g/kg
First trimester: EER + 0
Second trimester: EER + 340 kcal
Third trimester: EER + 452 kcal
First trimester: unchanged; standard protein recommendations
Second/Third trimester: 1.1 g/kg
Calories: 30 to 35 kcal/kg or 35 to 40 kcal/kg for patients losing weight
*Adjust energy based on weight change or level of obesity
Protein: 1.25 to 1.5 g/kg
Fluid: 30 ml/kg or 1 to 1.5 ml/kcal
Calories: 30 to 35 kcal/kg
Protein: 1.5 to 2 g/kg
Calories: 20 to 35 kcal/kg, depending on stage of trauma
Protein: upper end of 1.2 to 2 g/kg
Don’t miss our other resources for acute care dietitians, like the
TPN Troubleshooting Guide and how to get order writing privileges implemented!
Stacey Phillips, MS, RD is a clinical dietitian working with general medicine, oncology, CKD, renal transplant recipients and living kidney donor patients. Outside of her work, Stacey is passionate about improving the resources available to individuals with chronic kidney disease and actively participates on several renal dietitian committees.
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McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. JPEN. 2016;40(2):159-211.
Mueller CM. The A.S.P.E.N. Adult Nutrition Support Core Curriculum. 3rd ed. 2017.
National Kidney Foundation. Pocket Guide to Nutritional Assessment of the Patient with Kidney Disease. 6th ed.