Why do dialysis patients require so much protein? What are Mr. D’s current estimated calorie and protein needs?

A Patient with Diabetes Receiving Dialysis

Referral Information: Mr. D is a 48 year old Caucasian male with poorly managed type 2 diabetes for over 15 years and has been on dialysis three times a week for 1 year. Medical records reveal that his diabetes was most likely obesity related and was never well controlled. Mr. D required insulin shots soon after his initial diagnosis. 1 year ago his friend found him unconscious in his apartment and took him to the hospital. Upon admission, his blood sugar  was over 700 mg/dl. He was already in the pre-dialysis stages of kidney disease prior to this hospital stay. His friend reported that he rarely saw Mr. D check his blood sugar or administer insulin shots. His friend also informed the hospital’s nurse that Mr. D once told him that he could lose weight fast by letting his blood sugars get really high and skipping insulin doses.Address the following questions in a paragraph-type format:
Why did Mr. D’s kidneys fail (requiring dialysis)? Why was Mr. D’s risk for developing End Stage Renal Disease (ESRD) higher compared to other type 2 diabetic patients?
What caused Mr. D’s excessive weight loss from age 33 to 47? (Diabetes diagnosis to the start of dialysis?) What contributed to the weight loss in since he started dialysis? (one year ago) Choose several applicable nutritional diagnoses phrases/ nutrition problems from the phrases listed on the Nutrition diagnostic document  in course resources (some phrases are listed in the text: Ch 10). Which one do you think is the most important and why?
Why do dialysis patients require so much protein? What are Mr. D’s current estimated calorie and protein needs?
Are there any referrals to community programs that may help Mr. D? What can be done to increase his compliance with the dietary and medical therapies?
How can Mr. D’s compliance be assessed? Which assessment methods and tools should be utilized? (Weight monitoring, clinical/social referrals/background info, labs, etc.)