Table 2.
Suggested strategies to screen and assess nutritional status in advanced CKD
| Variable | Threshold for Detailed Assessment/Intervention | Relevant to Case? |
| Screening | ||
| Body weight | Continuous decline or <85% IBW | Yes |
| Dietary nutrient intake | ||
| DEI (kcal/kg IBW/d) | <25 | Yes |
| DPI (g/kg IBW/d) | <0.8 | Yes |
| Serum albumin (g/dl) | <4.0 | Yes |
| Serum creatinine | Relatively low value | Yes but subtle |
| MST | >2 | Yes |
| Assessment | ||
| Serum prealbumin (mg/dl) | <28 | ND |
| hsCRP (mg/dl) | >10 | ND |
| Anthropometrics | Deviation from norms | ND |
| SGA | B or C (moderately or severely malnourished) | ND (presumed score B or C) |
| MIS | >5 | ND |
| Diagnosis (2 of the 4) | ||
| Serum chemistry | ||
| Albumin (g/dl) | <3.8 | Yes |
| Prealbumin (mg/dl) | <28a | ND |
| Cholesterol (mg/dl) | <100 | ND |
| Body mass | ||
| BMI (kg/m2) | <23 | No |
| Weight loss | >5% over 3 mo or 10% over 6 mo | Yes |
| Total body fat (%) | <10 | ND |
| Muscle mass | ||
| Muscle wasting | >5% over 3 mo or 10% over 6 mo | ND |
| Reduced MAMC | >10% reduction compared with norms | ND |
| Creatinine appearance (g/kg IBW) | <1 | ND |
| Dietary intake | ||
| Low DPI (g/kg IBW per d) | <0.8 | Yes |
| Low DEI (kcal/kg IBW per d) | <25 | Yes |
IBW, ideal body weight; DEI, dietary energy intake; DPI, dietary protein intake; MST, Malnutrition Screening Tool; hsCRP, high-sensitivity C-reactive protein; SGA, subjective global assessment; MIS: malnutrition inflammation score; MAMC, mid-arm muscle circumference; ND, not done.
a
Influenced by kidney function.