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Exam Review

Key Facts: CSR Exam

150

Total Items

125 scored + 25 pretest

3 hrs

Time Limit

CDR Specialist Candidate Handbook

54 of 125

Largest Domain

Intervention and Care Coordination

2,000 hrs

Required Experience

Renal practice as an RD within 5 years

$350

Exam Fee

CDR fee schedule

KDOQI 2020

Core Guideline

Clinical Practice Guideline for Nutrition in CKD

The CSR (Board Certified Specialist in Renal Nutrition) exam is administered by CDR at Pearson VUE test centers. It has 150 four-option multiple-choice questions (125 scored + 25 pretest) with a 3-hour limit and a $350 fee. Candidates need current RD status held at least 2 years and 2,000 renal practice hours as an RD within 5 years. The October 2023 outline weights Intervention and Care Coordination (54 items) most heavily, followed by Assessment and Diagnosis (48) and Quality Management and EBP (23).

Sample CSR Practice Questions

Try these sample questions to review concepts for the CSR exam. 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 who care for people with acute kidney injury, CKD stages 1–5, dialysis (in-center, home and peritoneal) or a kidney transplant. The CSR exam follows CDR's October 2023 content outline: nutrition assessment and diagnosis, intervention and care coordination across the kidney-disease continuum, and quality management and evidence-based practice, including KDOQI and KDIGO guidelines and CMS dialysis regulations.

Exam sponsor: CDR. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

150 questions

Time Limit

3 hours

Passing Score

Criterion-referenced (Angoff); no fixed percentage published

Exam / Certification Fees

$350

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

38.4%

Nutrition Assessment and Diagnosis

Anthropometrics, labs, NFPE, diet, medical and psychosocial history, tests, PES diagnosis

43.2%

Intervention and Care Coordination

Nutrient delivery, education, medications; AKI, CKD, dialysis, transplant, comorbidities; care coordination

18.4%

Quality Management and EBP

CMS regulations, quality improvement, KDOQI/KDIGO/Academy guidelines, research and protocols

Preparing for the CSR Exam

What You Need to Know

Passing score: Criterion-referenced (Angoff); no fixed percentage published
Exam length: 150 questions
Time limit: 3 hours
Exam / certification fees: $350 Official sources

Using Our Practice Resources

Work through all 100 available questions
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CSR: Suggested Study Strategy

1Memorize KDOQI 2020 protein: 0.55–0.60 g/kg (or 0.28–0.43 + ketoacids) for stable CKD 3–5 without diabetes, 0.6–0.8 with diabetes, and 1.0–1.2 on HD or PD; know that KDIGO 2024 suggests 0.8 g/kg for CKD G3–G5

2Know phosphorus bioavailability: commonly cited at about 20–50% for plant (phytate) sources, 40–60% for animal protein and up to 90–100% for inorganic additives; teach patients to avoid 'PHOS' additives

3Learn CMS timelines: initial assessment within the latter of 30 days or 13 HD sessions, follow-up within 3 months, then annual (stable) or monthly (unstable) reassessment

4Know sodium and fluid targets: KDOQI 2020 sodium below 2.3 g/day (KDIGO below 2 g/day); HD fluid about 1,000 mL plus urine output; keep UFR below 13 mL/kg/h

5Know CKD-MBD and anemia targets: PTH about 2–9 times the upper limit on dialysis (KDIGO 2017); Hb below 11.5 g/dL on ESAs; hold routine iron when ferritin exceeds 700 ng/mL or TSAT reaches 40% (KDIGO 2026)

Frequently Asked Questions

Who is eligible for the CSR exam?

CDR requires current RD status with CDR, RD status held at least 2 years from the original RD exam date by the time of the specialty exam, and 2,000 hours of renal nutrition practice as an RD within the past 5 years. Up to 800 of those hours may be substituted with qualifying education or professional experience.

What protein recommendations should I master?

KDOQI 2020: 0.55–0.60 g/kg/day (or 0.28–0.43 g/kg/day plus ketoacid analogues) for metabolically stable CKD 3–5 without diabetes; 0.6–0.8 g/kg/day for CKD 3–5 with diabetes; and 1.0–1.2 g/kg/day on hemodialysis or peritoneal dialysis. KDIGO 2024 instead suggests 0.8 g/kg/day for CKD G3–G5, avoiding more than 1.3 g/kg/day.

What phosphate binders should I know?

Calcium acetate and carbonate (limit calcium loading; KDIGO 2017 suggests restricting calcium-based binder doses), sevelamer, lanthanum carbonate (chewed), sucroferric oxyhydroxide (chewable, minimal iron absorption), ferric citrate (absorbed iron raises ferritin and TSAT), and short-term aluminum hydroxide only. All must be taken with meals and snacks, and since 2025 Medicare dialysis patients receive them through the dialysis facility.

How is hyperkalemia managed in dialysis patients?

First rule out non-diet causes: constipation, acidosis, drugs (RAAS blockers, trimethoprim, calcineurin inhibitors), missed or inadequate dialysis and hemolyzed samples. Then counsel on potassium sources, salt substitutes and leaching, and discuss potassium binders (patiromer, sodium zirconium cyclosilicate) or a bath change with the team. Severe hyperkalemia with ECG changes is an emergency.

How should I study for the CSR exam?

Plan roughly 60–100 hours over 8–12 weeks and weight your time to the 2023 outline: Intervention and Care Coordination (54 of 125 scored items), Nutrition Assessment and Diagnosis (48), and Quality Management and EBP (23). Know KDOQI 2020 statements and grades, key KDIGO numbers, CMS assessment timelines and the ESRD QIP.