The best predictor of declining nutritional status in early kidney failure is a GFR <60 ml/min. A GFR <60 ml/min is associated with decreases in the laboratory parameters of hemoglobin, serum albumin and bicarbonate, decreases in body weight/BMI and decreases in dietary intakes of protein and energy. Studies of various design (randomized controlled trials, cohort, nonrandomized controlled trials, and cross-sectional studies) have shown similar results. Therefore, patients with a GFR <60 ml/min/1.73 m² should undergo a nutrition assessment to evaluate for protein calorie malnutrition followed with appropriate intervention.

• Grade I means there is Good/Strong evidence supporting the statement;
• Grade II is Fair;
• Grade III is Limited/Weak;
• Grade IV is Expert Opinion Only;
• Grade V is Not Assignable.
• High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
• Moderate (B) means we are moderately confident in the effect estimate;
• Low (C) means our confidence in the effect estimate is limited;
• Very Low (D) means we have very little confidence in the effect estimate.
• Ungraded means a grade is not assignable.