Assessment of nutritional status in dialysis patients
- Shweta Bansal, MD, FASN
Shweta Bansal, MD, FASN
- Associate Professor of Medicine
- Division of Nephrology, UT Health Science Center at San Antonio
- Monique E Cho, MD
Monique E Cho, MD
- Division of Nephrology and Hypertension
- University of Utah School of Medicine
- Srinivasan Beddhu, MD
Srinivasan Beddhu, MD
- Professor of Medicine
- University of Utah School of Medicine
Dialysis patients are commonly depleted of protein and energy stores [1-5]. The degree to which protein and energy depletion is the result of deficient nutrition or, alternatively, protein and energy wasting is unclear. In 2009, the International Society of Renal Nutrition and Metabolism (ISRNM) recommended the terminology protein-energy wasting (PEW) syndrome to describe the loss of body protein mass and fuel reserves in patients with end-stage renal disease (ESRD) .
The assessment of nutritional status is a routine part of the care of maintenance dialysis patients in order to allow early recognition and treatment of PEW syndrome. Markers of PEW are among the strongest predictors of morbidity and mortality in ESRD patients [3,7].
This topic reviews our approach to the assessment of nutritional status among ESRD patients. The pathogenesis and treatment of PEW are discussed elsewhere. (See "Pathogenesis and treatment of malnutrition in maintenance hemodialysis patients".)
OUR APPROACH TO THE CLINICAL ASSESSMENT OF NUTRITIONAL STATUS
We perform monthly nutritional assessments of all dialysis patients. Our approach includes a dietary assessment, physical examination, and laboratory examination.
Our approach is detailed here.
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- OUR APPROACH TO THE CLINICAL ASSESSMENT OF NUTRITIONAL STATUS
- Dietary assessment
- Physical assessment
- Laboratory assessment
- - Serum albumin
- - Urea nitrogen and protein nitrogen appearance
- DIAGNOSIS OF PROTEIN-ENERGY WASTING
- PROPOSED CRITERIA FOR PROTEIN-ENERGY WASTING SYNDROME
- International Society of Renal Nutrition and Metabolism
- Subjective global assessment
- French protein-energy wasting score
- OTHER METHODS
- SUMMARY AND RECOMMENDATIONS