CKD: Nutritional Status: Technical Devices and Anthropometric Measures (2018)

Assessment
Is there evidence to support the use of bioimpedance spectroscopy (BIS) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Bioimpedance spectroscopy (BIS) demonstrated low bias/good agreement in measuring body composition compared to reference methods in hemodialysis patients (three studies), but validity was questionable and limited in renal transplant patients.
- Grade: III
  - 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: Is there evidence to support the use of bioimpedance spectroscopy (BIS) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of BMI for assessing body composition in adults with CKD on hemodialysis?
- Conclusion
  Body mass index (BMI), when defined in traditional categories or stratified into 5-11 categories, was a significant predictor of mortality at 1.34-10 years in hemodialysis (HD) participants. Underweight patients had higher risk of mortality, and overweight and obese patients generally had lower risk of mortality. BMI was positively associated with albumin levels, and fat and lean body mass measured by a variety of methods in HD patients, but the relationship between BMI and inflammatory markers was not clear. Variability in the strength of results may be due to age and metabolic status of participants as well as variability in BMI categories.
- 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: Is there evidence to support the use of BMI for assessing body composition in adults with CKD on hemodialysis?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of BMI for assessing body composition in adults with CKD, pre-dialysis and on peritoneal dialysis?
- Conclusion
  In peritoneal dialysis patients, underweight patients had higher risk of mortality, but there was no difference according to overweight/obesity status. In non-dialyzed participants, there may be a protective effect of overweight/obesity in metabolically healthy patients, but not in other patients.
- Grade: III
  - 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: Is there evidence to support the use of BMI for assessing body composition in adults with CKD, pre-dialysis and on peritoneal dialysis?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of conicity index for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on one study, Conicity Index may be a useful measure of nutritional status, inflammation and mortality in hemodialysis patients, but evidence was limited.
- Grade: III
  - 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: Is there evidence to support the use of conicity index for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of creatinine/kinetics for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  In hemodialysis patients, a creatinine kinetic model agreed with creatinine levels from dialysis (one study) and correlated with other traditional measures of muscle mass (two studies). Pre-dialysis, inter-dialytic change in creatinine and weekly creatinine clearance predicted mortality (three studies). Though creatinine kinetics were correlated with other body composition measures in peritonial dialysis patients (twp studies), authors noted significant differences between creatinine and anthropometric measures for lean body mass/fat free mass (one study). Evidence was limited in pre-dialysis patients, but suggests that while the creatinine kinetics method is moderately reproducible, skinfold measures may be more accurate (one study).
- Grade: III
  - 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: Is there evidence to support the use of creatinine/kinetics for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of dry mass index (DMI) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on one study, evidence to support the use of dry mass index to assess nutritional status in hemodialysis patients is not clear. Further research is warranted to understand the use of dry mass index in this population.
- Grade: III
  - 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: Is there evidence to support the use of dry mass index (DMI) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of mid-arm circumference (MAC) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Mid-arm circumference (MAC) was significantly correlated with other tools such as SGA, Malnutrition score and c-reactive protein (CRP) levels. However, evidence to support the use of MAC is not clear as it is based on cross sectional studies with small sample sizes. Further research is warranted to clearly understand the use of MAC in hemodialysis and peritoneal dialysis population.
- Grade: III
  - 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: Is there evidence to support the use of mid-arm circumference (MAC) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of mid-arm muscle circumference (MAMC) measurements for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Mid arm muscle circumference (MAMC) is significantly correlated with other tools like SGA and Malnutrition score. However, evidence to support the use of MAMC to predict mortality is not clear. Further research is warranted to understand the use of MAMC in hemodialysis and peritoneal dialysis population.
- Grade: III
  - 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: Is there evidence to support the use of mid-arm muscle circumference (MAMC) measurements for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of multi-frequency bioelectrical impedance (MF-BIA) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Fat mass and fat free mass measured by MF-BIA had good agreement with DEXA (two studies), high correlations with most nutritional status markers (three studies) and predicted hard outcomes (four studies) in hemodialysis patients. However, in peritoneal dialysis, renal transplant and pre-dialysis patients, evidence is too limited to draw conclusions.
- Grade: III
  - 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: Is there evidence to support the use of multi-frequency bioelectrical impedance (MF-BIA) for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of Near-Infrared Interactance for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  IRI was a valid measure of body composition compared to DEXA (one study), and reliable with low coefficients of variation (one study) and significant correlations with other body composition markers (four studies) in dialysis patients.
- Grade: III
  - 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: Is there evidence to support the use of Near-Infrared Interactance for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of single-frequency bioelectrical impedance (SF-BIA) for assessing body composition in adults with CKD 1-5D and post-transplant?
Is there evidence to support the use of skinfold measurements for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on validity/reliability and correlation studies, skinfold measurements are valid for assessing percentage of body fat in the CKD population. Skinfold measurements are simple and inexpensive to conduct and are not influenced by fluid status.
- 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: Is there evidence to support the use of skinfold measurements for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of unintended weight loss for assessing nutritional status in adults with CKD on hemodialysis?
- Conclusion
  Based on one validation study and one prediction study in patients on hemodialysis, the use of unintended loss in conjunction with albumin and BMI has good sensitivity and specificity to detect malnutrition and unintended weight loss is independently associated with mortality. Unintended weight loss is an indicator of risk.
- 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: Is there evidence to support the use of unintended weight loss for assessing nutritional status in adults with CKD on hemodialysis?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)
Is there evidence to support the use of waist circumference for assessing body composition in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on two studies, evidence to support the use of waist circumference to assess nutritional status in peritoneal dialysis and hemodialysis patients is not clear. However, waist circumference is a quick and easy method to use.
- Grade: III
  - 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: Is there evidence to support the use of waist circumference for assessing body composition in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Technical Devices and Anthropometric Measures (2018)