Chronic Kidney Disease

CKD: Nutrition Assessment and Best Predictors of CKD (2001)

Nutrition Assessment and CKD (2001)

• Assessment
  What is the best predictor of declining nutritional status in early kidney failure? (2001 CD)

  • Conclusion

    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: II
    • 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.
  • Evidence Summary: Nutrition Assessment and Intervention in Chronic Kidney Disease (2001)
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Caravaca F, Arrobas M, Pizarro JL, Sanchez-Casado E. Uraemic symptoms, nutritional status and renal function in pre-dialysis end-stage renal failure patients.  Nephrol Dial Transplant.  2001;16:776-782.  
      • Goldstein DJ, Callahan C. Strategies for nutritional intervention in patients with renal failure.  Miner Electrolyte Metab. 1998;24:82-91.  
      • Ikizler TA, Greene JH, Wingard RL, Parker RA, Hakim RM. Spontaneous dietary protein intake during progression of chronic renal failure. J Am Soc Nephrol. 1995; 6:1386-1391.
      • Iseki K, Uehara H, Nishime K, Tokuyama K, Yoshihara K, Kinjo K, Shiohira Y, Fukiyama K.  Impact of the initial levels of laboratory variables on survival in chronic dialysis patients.  Am J Kidney Disease. 1996; 28: 541-548.  
      • Kopple JD, Greene T, Chumlea WC, Hollinger D, Maroni BJ, Merrill D, Scherch LK, Shulman G, Wang S-R, Zimmer GS.  Relationship between nutritional status and the glomerular filtration rate: results from the MDRD Study.  Kidney Int. 2000; 57:1688-1703.
      • Kopple JD, Berg R, Houser H, Steinman TI, Teschan P. Nutritional status of patients with different levels of chronic renal insufficiency. Modification of Diet in Renal Disease (MDRD) Study Group. Kidney Int. 1989; 36(suppl 27): S184-S194.
      • Mitch WE. Mechanisms causing muscle wasting in uremia.  J Renal Nutr. 1996;6:75-78.
      • Pollock CA, Ibels LS, Zhu F-Y, Warnant M, Caterson RJ, Waugh DA, Mahony JF.  Protein intake in renal disease.  J Am Soc Nephrol. 1997; 8:777-783.  
      • Soucie JM, McClellan WM.  Early death in dialysis patients: risk factors and impact on incidence and mortality rates.  J Am Soc Nephrol.  1996;7:2169-2175.  
      • Sreedhara R, Avram MM, Blanco M, Batish R, Avram MM, Mittman N.  Prealbumin is the best nutritional predictor of survival in hemodialysis and peritoneal dialysis.  Am J Kidney Disease. 1996;28:937-942.
      • Williams B, Hattersley J, Layward E, Walls J.  Metabolic acidosis and skeletal muscle adaptation to low protein diets in chronic uremia.  Kidney Int. 1991; 40: 779-786.