100+ Free CSR Practice Questions

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A CKD stage 4 patient has serum bicarbonate of 19 mEq/L. KDOQI recommends maintaining serum bicarbonate at what level to slow CKD progression?

>=30 mEq/L

Bicarbonate level is not relevant in CKD

>=15 mEq/L

>=22 mEq/L

to track

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2026 Statistics

Key Facts: CSR Exam

150

Total Items

125 scored + 25 pretest

3 hrs

Time Limit

CDR

36%

Largest Domain Weight

Nutrition Assessment

2,000 hrs

Required Experience

Renal nutrition within 5 years

$350

US Exam Fee

$475 international

KDOQI 2020

Core Guideline

Clinical Practice Guideline for Nutrition in CKD

The CSR (Board Certified Specialist in Renal Nutrition) exam is administered by CDR. The exam consists of 150 multiple-choice items (125 scored + 25 pretest) over 3 hours. The fee is $350 US / $475 international. Eligibility requires an active RD/RDN credential plus 2,000 hours of renal nutrition practice within the past 5 years. Nutrition Assessment is the largest domain at 36%, followed by Intervention (25%). KDOQI 2020 is the central reference. Year-round PSI testing.

Sample CSR Practice Questions

Try these sample questions to test your CSR exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Which calculation BEST estimates dry weight assessment in a hemodialysis patient with persistent hypertension and edema?

A.Pre-dialysis weight minus 1 kg arbitrarily

B.Post-dialysis weight at which the patient is normotensive without symptomatic hypotension and free of edema

C.Ideal body weight from Hamwi equation

D.Body weight measured in the morning before breakfast

Explanation: Estimated dry weight (EDW) is the lowest post-dialysis weight a patient can tolerate without intradialytic hypotension or symptoms while maintaining normal blood pressure and being free of edema. KDOQI 2020 supports clinical assessment combined with bioimpedance or lung ultrasound when available. Pre-defined formulas or arbitrary subtractions do not account for fluid status, body composition shifts, or comorbidities.

2A 62-year-old man on in-center hemodialysis has a serum albumin of 3.2 g/dL, BMI 21, and reports decreased appetite for 3 months. Which assessment tool is MOST validated for diagnosing protein-energy wasting (PEW) in dialysis patients?

A.Mini Nutritional Assessment (MNA)

B.Subjective Global Assessment (SGA) or Malnutrition Inflammation Score (MIS)

C.Body Mass Index alone

D.Serum prealbumin trend

Explanation: KDOQI 2020 recommends 7-point SGA or the Malnutrition Inflammation Score (MIS) as validated tools to assess nutritional status and PEW in maintenance dialysis. MNA is validated in geriatric populations but not dialysis. BMI and single biochemical markers like albumin are confounded by inflammation and volume status and should not be used alone.

3Which method does KDOQI 2020 recommend for routinely assessing protein intake in maintenance hemodialysis patients?

A.24-hour dietary recall only

B.Normalized protein catabolic rate (nPCR or nPNA) from urea kinetics

C.Food frequency questionnaire

D.Serum BUN alone

Explanation: Normalized protein nitrogen appearance (nPNA, also called nPCR) derived from urea kinetic modeling is the standard objective measure of dietary protein intake in stable HD patients. KDOQI 2020 endorses combining nPNA with dietary interviews. Serum BUN alone does not differentiate intake from clearance, and food recall lacks precision in this population.

4What is the equation most commonly used to estimate GFR in adult CKD staging?

A.Cockcroft-Gault

B.CKD-EPI 2021 creatinine equation

C.Schwartz equation

D.Harris-Benedict equation

Explanation: The CKD-EPI 2021 creatinine equation (race-free) is the current recommended equation for estimating GFR in adults to stage CKD. Cockcroft-Gault estimates creatinine clearance and is used primarily for drug dosing. Schwartz is pediatric-specific. Harris-Benedict estimates basal energy expenditure, not GFR.

5A patient with eGFR of 28 mL/min/1.73 m2 and 800 mg/day of urinary albumin would be classified as which CKD stage and albuminuria category?

A.G3a, A1

B.G3b, A2

C.G4, A3

D.G5, A3

Explanation: GFR 15-29 mL/min/1.73 m2 is stage G4. Albuminuria >300 mg/day (or ACR >300 mg/g) is category A3 (severely increased). KDIGO uses both GFR and albuminuria to stage and prognosticate CKD risk.

6When measuring height in a non-ambulatory adult dialysis patient, which method is MOST appropriate?

A.Self-reported height from medical record

B.Knee height using a sliding caliper with age- and sex-specific equation

C.Arm span only

D.Estimated from body weight

Explanation: Knee height with a sliding caliper combined with validated equations (e.g., Chumlea) provides the most accurate height estimate in non-ambulatory adults. Self-reported height is unreliable, particularly in older patients with vertebral compression. Arm span is acceptable when knee height is not feasible but is less standardized.

7A peritoneal dialysis patient using 4 exchanges of 2 L 2.5% dextrose dialysate gains approximately how many kcal per day from glucose absorption?

A.100-200 kcal

B.300-500 kcal

C.800-1,000 kcal

D.1,500-2,000 kcal

Explanation: PD patients absorb roughly 60-80% of dialysate glucose; for a typical CAPD prescription using 2.5% dextrose this contributes about 300-500 kcal/day. KDOQI 2020 instructs RDNs to subtract this energy contribution when calculating dietary energy needs to avoid overfeeding and weight gain.

8Which biochemical parameter is the BEST single indicator of recent dietary phosphorus intake in a stable HD patient?

A.Serum phosphorus drawn pre-dialysis

B.Serum calcium

C.Serum magnesium

D.Serum albumin

Explanation: Pre-dialysis serum phosphorus is the routine indicator used to monitor phosphorus management; persistently elevated levels suggest inadequate dietary control, binder non-adherence, increased bone turnover, or insufficient dialysis. Calcium and magnesium reflect different processes, and albumin reflects nutrition and inflammation.

9Adjusted body weight is recommended in CKD nutrition assessment when actual body weight differs from standard body weight by what threshold?

A.<95% or >115% of standard body weight (SBW)

B.<90% or >110% SBW

C.Only when BMI <18.5

D.Never; always use actual body weight

Explanation: KDOQI guidance recommends using adjusted edema-free body weight (aBWef) for nutrient calculations when the patient's weight is <95% or >115% of standard body weight from NHANES II tables. This avoids over- or under-estimating needs in underweight or obese patients.

10Which nutrition-focused physical exam (NFPE) finding is MOST suggestive of muscle wasting in a chronic HD patient?

A.Bilateral lower-extremity edema

B.Hollowing at the temples and prominent clavicles with decreased quadriceps mass

C.Spoon-shaped nails

D.Cheilosis at the corners of the mouth

Explanation: Temporal hollowing, prominent clavicles, decreased deltoid and quadriceps muscle mass are classic NFPE findings of muscle wasting and PEW. Edema reflects fluid status. Spoon nails (koilonychia) suggest iron deficiency, and cheilosis suggests B-vitamin deficiency.

About the CSR Exam

Specialty certification for Registered Dietitians providing nutrition care across the kidney disease continuum — CKD G1-G5, all dialysis modalities (in-center HD, PD, home HD, nocturnal), transplant, AKI on CRRT, and pediatric kidney disease. The CSR validates expertise in KDOQI 2020 nutrition guidelines, protein-energy wasting (PEW) assessment and management, electrolyte management (K, P, Na, Ca, Mg, fluid), CKD-MBD pharmacology (binders, vit D analogs, calcimimetics), anemia management, and the unique regulatory environment of dialysis facilities (CMS Conditions for Coverage).

Questions

150 scored questions

Time Limit

3 hours

Passing Score

Scaled

Exam Fee

$350 US / $475 international (CDR)

CSR Exam Content Outline

36%

Nutrition Assessment & Re-assessment

CKD staging, modalities, KDOQI 2020, PEW assessment, nPCR/Kt/V

15%

Nutrition Diagnosis

Renal-specific PES, PEW diagnosis, electrolyte imbalances, fluid status, CKD-MBD

25%

Nutrition Intervention

KDOQI 2020 protein, phosphorus/K binders, vit D analogs, anemia, plant-based PLADO

18%

Nutrition Monitoring & Evaluation

Lab interpretation, dialysis adequacy, nPCR, growth in peds

Quality Management & EBP

CMS Conditions for Coverage, QAPI, interdisciplinary team, education

How to Pass the CSR Exam

What You Need to Know

Passing score: Scaled
Exam length: 150 questions
Time limit: 3 hours
Exam fee: $350 US / $475 international

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

CSR Study Tips from Top Performers

1Memorize KDOQI 2020 protein: CKD 1-2 = 0.8 g/kg; CKD 3-5 non-dialysis without DM = 0.55-0.6 (LPD) or 0.28-0.43+KAA (VLPD); CKD 3-5 with DM = 0.6-0.8; HD/PD = 1.0-1.2; transplant 1.4 g/kg first month then 0.6-0.8

2Know phosphorus bioavailability: plant-based ~40-60%, animal 70-80%, additives ~90%. Educate patients to AVOID phosphate-containing additives (preservatives in deli meats/sodas/processed foods)

3Master the 6 phosphorus binder classes and their distinguishing features, side effects, and pill burden

4Know fluid restriction in HD: 1,000 mL/day + urine output (interdialytic weight gain target <2 kg or 5% dry weight). PD allows more fluid

5Understand CKD-MBD targets: PTH 2-9× ULN in dialysis (KDIGO 2017 update from previous strict targets), Ca × P product <55 mg²/dL² in dialysis, phosphorus <5.5 in dialysis

Frequently Asked Questions

Who is eligible for the CSR exam?

You need an active CDR Registered Dietitian (RD or RDN) credential held for at least 2 years plus a minimum of 2,000 hours of documented renal nutrition practice within the past 5 years. The exam is offered year-round through PSI test centers.

What protein recommendations should I master?

Per KDOQI 2020 Clinical Practice Guideline for Nutrition in CKD: CKD 1-2 not on dialysis 0.8 g/kg/d; CKD 3-5 not on dialysis without diabetes 0.55-0.6 g/kg/d (LPD) OR 0.28-0.43 g/kg + ketoacid analogs (very LPD); CKD 3-5 with diabetes 0.6-0.8 g/kg; HD or PD 1.0-1.2 g/kg/d (≥50% high biological value); transplant 1.4 g/kg first month then 0.6-0.8 maintenance.

What phosphorus binders should I know?

Six classes: calcium-based (calcium acetate PhosLo, calcium carbonate — limit total elemental Ca ≤1,500 mg/d), sevelamer (Renvela — also lowers LDL), lanthanum carbonate (Fosrenol — chewable), sucroferric oxyhydroxide (Velphoro — iron-based, dark stools), ferric citrate (Auryxia — iron-based, replaces IV iron), aluminum hydroxide (rare, only short-term). Bind with meals; spacing matters for non-renal medications.

How do you manage hyperkalemia in dialysis patients?

First-line: dietary K education (limit potatoes/tomatoes/oranges/bananas/dried fruit/spinach/nuts/beans; leach potatoes if used; choose lower-K substitutes). Identify culprits: ACE-i/ARB, K-sparing diuretics, food sources, missed dialysis. Newer K binders patiromer (Veltassa) and sodium zirconium cyclosilicate (Lokelma) for chronic management. Acute: kayexalate fallen out of favor due to colonic necrosis risk; calcium gluconate for cardiac protection if EKG changes; insulin/dextrose, beta-agonist, dialysis.

How should I study for the CSR exam?

Plan 60-100 hours over 8-12 weeks. Focus heaviest on Nutrition Assessment (36%) and Nutrition Intervention (25%) — together 61% of exam. Master KDOQI 2020 protein recommendations across all stages and modalities, all 6 phosphorus binder classes, K binders (patiromer, SZC), CKD-MBD pharmacology (calcitriol, paricalcitol, calcimimetics), anemia management (ESAs, IV iron), and the plant-based PLADO emerging evidence.