Recent advances in the pathophysiology and management of protein-energy wasting in chronic kidney disease

Table 6 A proposed criteria for the clinical diagnosis of PEW in CKD patients

Criteria
Serum chemistry
Serum albumin <3.8 g/dL^a
Serum prealbumin (transthyretin) <30 mg/dL (for maintenance dialysis)
Serum cholesterol <100 mg/dL^a
Body mass
Body mass index (BMI) <23^b
Unintentional weight loss over time: 5 % over 3 months or 10 % over 6 months
Total body fat percentage <10 %
Muscle mass
Reduced muscle mass 5 % over 3 months or 10 % over 6 months
Reduced mid-arm muscle circumference area^c (reduction >10 % in relation to the 50th percentile of reference population)
Creatinine appearance^d
Dietary intake
Unintentional low dietary protein intake <0.80 g/kg/day for at least 2 months^e for dialysis patients or <0.6 g/kg/day for patients with CKD G2-5
Unintentional low dietary energy intake <25 kcal/kg/day for at least 2 months

At least three of the four listed categories along with at least one test in each of the selected categories must be satisfied for the diagnosis of CKD-related PEW. Each criterion should be documented on at least three occasions, preferably 2–4 weeks apart
^aNot valid in abnormally great urinary or gastrointestinal protein losses, liver disease, or cholesterol-lowering medications
^bA lower BMI might be favorable in certain Asian populations
^cMeasurement must be performed by a trained anthropometrist
^dCreatinine appearance is influenced by both muscle mass and meat intake
^eCan be assesed by dietary diaries and interview, or for protein intake by calculation of normalized protein equivalent of total nitrogen appearance (nPNA or nPCR) as determined by urea kinetic measurements

ISSN: 2059-1381