Table 1.
Diagnostic criteria for clinical diagnosis of PEW in patients with CKD, as suggested by and adapted from Abraham et al [5].
| Adult Criteria [5] | Modification for Children [4] |
|---|---|
| Serum chemistry | |
| Serum albumin < 3.8 g per 100 mL (Bromocresol Green) | No modification, although specificity of albumin as an indicator of PEW is not assured |
| Serum prealbumin (transthyretin) <30 mg per 100 mL (for maintenance dialysis patients only; levels may vary according to GFR level for patients with CKD Stages 2–5) | No modification although the same issues exist as with albumin |
| Serum cholesterol <100 mg per 100 mL | No data exists for association of low cholesterol and outcomes in children with CKD |
|
| |
| Body mass | |
| BMI < 23 | BMI expressed as percentile or Z score relative to age & sex. Alternatively, BMI for height-age |
| Unintentional weight loss over time: 5% over 3 months or 10% over 6 months | Failure to gain weight appropriately, as evidenced by crossing of BMI percentiles |
| Total body fat percentage <10% | Decrease in percent body fat over time in relation to growth and development |
|
| |
| Muscle mass | |
| Reduced muscle mass 5% over 3 months or 10% over 6 months | No modification |
| Reduced mid-arm muscle circumference area (reduction > 10% in relation to 50th percentile of reference population) | No modification; although dual energy x-ray absorptiometry is a more accurate marker of muscle mass in children |
| Creatinine appearance | Not a valid criteria in children as reference values are not available for children |
|
| |
| Dietary intake | |
| Unintentional low DPI < 0.8 g/kg per day for ≥ 2 months for dialysis pt’s or < 0.6 g/kg per day for pt’s with CKD stages 2–5 | Not evaluated in children as accurate predictor of PEW |
| Unintentional low DEI < 25 kcal/kg per day for ≥ 2 months | Not evaluated in children as accurate predictor of PEW |
At least three out of the four listed categories (and at least one test in each of the selected category) must be satisfied for the diagnosis of kidney disease-related PEW. Optimally, each criterion should be documented on at least three occasions, preferably 2–4 weeks apart.
BMI: body mass index, DPI: dietary protein intake, DEI: dietary energy intake