Table 1.

Suggested Table to Monitor Nutritional Status and Guide Therapy in Kidney Failure

Simple (Monthly) Assessment	Findings	Possible Interventions
BW Serum albumin	Continuous decline or <85% IBW <4.0 g/dL	Suspect uremic malnutrition and perform more detailed nutritional assessment
Serum creatinine	Relatively low predialysis values	No intervention needed at this point
Detailed Assessment		Possible Interventions (simple)
Serum prealbumin	<30 mg/dL, and/or	Dietary counseling: DPI ≥ 1.2 g/kg/d, energy intake 30–35 kcal/d
Serum transferrin	<200 mg/dL, and/or
IGF-1	<200 ng/mL, and/or	CHD and peritoneal dialysis
LBM and/or fat mass	Unexpected decrease	Increase dialysis dose to Kt/V > 1.4
SGA	Worsening	Use biocompatible membranes
		Upper gastrointestinal motility enhancer
		CKD
		Consider timely initiation of CDT
Repeat Detailed Assessment (2–3 months from previous)		Possible Interventions (moderate to complex)
Serum prealbumin	<30 mg/dL, and/or	Nutritional supplements:
Serum transferrin	<200 mg/dL, and/or	Oral, enteric tube feeding, IDPN (requires Medicare approval)
IGF-I	<200 ng/mL, and/or
Serum creatinine	Relatively low predialysis values, and/or	Anabolic factors (experimental): rhGH, rhIGF-I
LBM and/or fat mass
C-reactive protein<	unexpected decrease >10 mg/L	Appetite stimulants (experimental)
		Anti-inflammatory (experimental)

Adapted with permission from Pupim et al.³⁸

Abbreviations: BW, body weight; IBW, ideal body weight; IGF-1, insulin-like growth factor-1; LBM, lean body mass; SGA, subjective global assessment; DPI, dietary protein intake; CDT, chronic dialysis treatment.