Assessment of nutritional status in end-stage renal disease
- Marsha Wolfson, MD, FACP
Marsha Wolfson, MD, FACP
- Clinical Professor of Medicine
- University of Oregon Health Sciences Center
Depending in part upon the method used and the population studied, from 40 to 70 percent of patients with end-stage renal disease (ESRD) are malnourished [1-10], a complication that appears to be associated with increased mortality [8,9]. (See "Patient survival and maintenance dialysis", section on 'Malnutrition'.)
As a result of the frequency of malnutrition, periodic assessment of nutritional status should be part of the routine care of dialysis patients to permit early recognition and the institution of appropriate therapy (table 1). Most of the standard methods of assessing nutritional status can be applied to patients with renal failure; however, some of these parameters are altered by uremia. It is therefore helpful to review briefly the characteristics of the different tests that are used.
METHODS OF ASSESSING NUTRITIONAL STATUS
There is no single measurement that can be used to determine the presence of malnutrition . Therefore, a panel of measurements is recommended, including measures of body mass (body mass index [BMI]) and composition, a measure of dietary protein and energy intake, and at least one measure of serum protein status (table 2) .
History and physical examination — The history and physical examination can often provide important clues to the patient who might be malnourished. These include:
●Symptoms such as nausea, vomiting, anorexia, or weight loss or gain. Large interdialytic weight gain is discouraged because it is thought to reflect excessive fluid and sodium intake. In some cases, however, over time, increased body weight gain may represent improved nutritional status . A careful assessment should be performed to distinguish between these possibilities.
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- METHODS OF ASSESSING NUTRITIONAL STATUS
- History and physical examination
- Food intake
- Plasma protein measurements
- - Albumin
- - Transferrin
- - Prealbumin
- - Amino acids
- Plasma cholesterol concentration
- Blood urea nitrogen
- Creatinine production
- CLINICAL APPROACH
- SUMMARY AND RECOMMENDATIONS