Table 2.

Suggested strategies to screen and assess nutritional status in advanced CKD

VariableThreshold for Detailed Assessment/InterventionRelevant to Case?
 Body weightContinuous decline or <85% IBWYes
 Dietary nutrient intake
  DEI (kcal/kg IBW/d)<25Yes
  DPI (g/kg IBW/d)<0.8Yes
 Serum albumin (g/dl)<4.0Yes
 Serum creatinineRelatively low valueYes but subtle
 Serum prealbumin (mg/dl)<28ND
 hsCRP (mg/dl)>10ND
 AnthropometricsDeviation from normsND
  SGAB or C (moderately or severely malnourished)ND (presumed score B or C)
Diagnosis (2 of the 4)
 Serum chemistry
  Albumin (g/dl)<3.8Yes
  Prealbumin (mg/dl)<28aND
  Cholesterol (mg/dl)<100ND
 Body mass
  BMI (kg/m2)<23No
  Weight loss>5% over 3 mo or 10% over 6 moYes
  Total body fat (%)<10ND
 Muscle mass
  Muscle wasting>5% over 3 mo or 10% over 6 moND
  Reduced MAMC>10% reduction compared with normsND
  Creatinine appearance (g/kg IBW)<1ND
 Dietary intake
  Low DPI (g/kg IBW per d)<0.8Yes
  Low DEI (kcal/kg IBW per d)<25Yes
  • 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.