Would you perform dialysis on a patient with altered mental status in the setting of an elevated blood urea nitrogen level attributed to a tube feeding diet?

Uremia is symptomatic azotemia, I don't see how you don't dialyze that patient. The idea behind tube feeds is nutrition, that you need amino acids to make protein, but if the BUN is rising, clearly you are catabolizing some of them, and I would check with the dietician to make sure the patient isn't getting excessive AAs. In the "old days" (early 80s) we would protein restrict to lessen azotemia and avoid dialysis. Now that is not appropriate, patients need to be fed and if that means you need to dialyze them, then so be it. You just don't need to overfeed them either, because some protein may improve their nutritional status. but more protein does not necessarily improve nutritional status (serum albumin) any better or faster than less, and all you do is create more urea. How much is enough protein? I have no idea.