Table 1.

Nutritional assessment parameters and their limitations (DEXA dual-energy X-ray absorptiometry)

Parameter	Limitation
Weight	False elevation due to fluid overload
Height	Influenced by alterations of growth hormone axis, delayed puberty, renal osteodystrophy, independent of nutritional state
MAC and triceps	Can be influenced by altered regional distribution of fat/muscle
Skin fold thickness
Bio-impedance	Unpredictable effect on estimation of fat-free mass from total body water in renal failure
Albumin/pre-albumin	Albumin level associated with outcome, but levels influenced by inflammation and fluid overload; also limited by long half-life. Pre-albumin shorter half-life but influenced by inflammation and fluid overload
Bone density (DEXA)	Fluid overload can cause overestimation of lean mass
Normalized protein catabolic rate (nPCR)	Only few studies available but emerging as nutrition marker for children receiving HD

MAC mid arm circumference