Table 1.
Criteria for the clinical diagnosis of cachexia and protein-energy wasting.
| Criteria | Cachexia (Cachexia Consensus Working Group) |
Protein-Energy Wasting (International Society of Renal Nutrition and Metabolism) |
|---|---|---|
| Dietary intake (Anorexia) |
Unintentional low dietary energy intake < 20 kcal/kg/day Unintentional low dietary energy intake < 70% of usual food intake Poor appetite |
Unintentional low dietary protein intake < 0.80 g/kg/day for at least 2 months for dialysis patients or <0.6 g/kg/day for patients with CKD stages 2–5 Unintentional low dietary energy intake < 25 kcal/kg/day for at least 2 months |
| Serum chemistry | Serum albumin < 3.2 g/dL | Serum albumin < 3.8 g/dL |
| Anaemia: haemoglobin < 12 g/dL | Serum pre-albumin (transthyretin) < 30 mg/dL (for maintenance dialysis patients only; levels may vary according to GFR level for patients with CKD stages 2–5) | |
| Increased inflammatory markers: CRP > 0.5 mg/dL, IL-6 > 4.6 pg/mL | Serum cholesterol < 100 mg/dL | |
| Body mass | N/A | BMI < 23 kg/m2 (a lower BMI might be desirable for certain Asian population; weight must be oedema-free mass, for example, post-dialysis dry weight) Unintentional weight loss over time: 5% over 3 months or 10% over 6 months Total body fat percentage < 10% |
| Muscle mass | Reduced mid-upper arm muscle circumference < 10th percentile for age and sex Reduction in appendicle skeletal muscle index on DEXA (kg/m2) by <5.45 and <7.25 in women and men, respectively |
Muscle wasting: reduced muscle mass 5% over 3 months or 10% over 6 months Reduced mid-arm muscle circumference (reduction > 10% in relation to 50th percentile of reference population) Low creatinine appearance |
| Muscle strength | Decreased muscle strength (lowest tertile, e.g., handgrip strength | N/A |
| Fatigue | Physical or mental weariness resulting from exertion; inability to continue exercise at the same intensity with a resultant deterioration in performance | N/A |
| Diagnosis of cachexia/PEW | Weight loss of at least 5% in 12 months or less in the presence of underlying illness, plus three of the other criteria | At least three of the four listed categories (and at least one test in each of the selected categories) |
BMI, body mass index; CKD, chronic kidney disease; CRP, C-reactive protein; DEXA, dual-energy X-ray absorptiometry; GFR, glomerular filtration rate; IL-6, interleukin-6; N/A, not applicable; PEW, protein-energy wasting.