CKD: Nutritional Status: Composite Nutritional Indices (2018)

Assessment
Is there evidence to support the use of the 7-point SGA for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  The 7-point SGA scale was a reliable (two studies) and valid (one study) tool to assess nutritional status and predict mortality in patients on hemodialysis (HD) (three studies), peritoneal dialysis (PD) (one study) and both HD and PD (one study). The 7-point SGA score correlated with anthropometric measurements in patients on HD (3 studies) and a range of CKD patients (1 study) and body composition measurements and albumin levels among in HD patients (4 studies).
- 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 the 7-point SGA for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the 3-point SGA for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  The 3-point SGA score was valid (one study) and moderately reliable in patients on hemodialysis (HD) (one study) and correlated with common measures of nutritional status, including biochemical, anthropometric and body composition measures (two studies with patients on HD and one study with patients on PD), and was predictive of one and three-year mortality in patients on HD (two studies), but this score may misclassify nutritional status as defined by total body nitrogen in patients on HD (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 the 3-point SGA for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Body Adiposity Index (BAI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of body adiposity index as a tool to assess nutrition status in non-dialyzed patients in not clear based on one study. Based on one study body adiposity index demonstrates high accuracy, however, further research is warranted.
- 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 the Body Adiposity Index (BAI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Silva M, Vale B, Lemos C, Torres M, Bregman R. Body adiposity index assess body fat with high accuracy in nondialyzed chronic kidney disease patients. Obesity 2013; 21:546-52
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Composite Score of Protein Energy Nutrition Status (cPENS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of Composite Score of Protein Energy Nutrition Status (cPENS) as a tool to assess nutrition status in hemodialysis patients in not clear based on one study. Based on one study cPENS had inadequate discrimination and calibration or a lower predictive value for mortality.
- 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 the Composite Score of Protein Energy Nutrition Status (cPENS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Geriatric Nutrition Risk Index (GNRI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Geriatric Nutrition Risk Index (GNRI) is a valid and reliable tool to assess nutritional status in patients on maintenance hemodialysis patients. GNRI is also a good predictor of mortality based on one study.
- 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 the Geriatric Nutrition Risk Index (GNRI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Integrative Score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of integrative score as a tool to assess nutrition status in hemodialysis patients in not clear based on one study. Based on one study integrative score is a useful prognostic tool to detect early nutrition deterioration, however, further research is warranted.
- 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 the Integrative Score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the International Society of Renal Nutrition and Metabolism (ISRNM) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of the International Society of Renal Nutrition and Metabolism (ISRNM) as a tool to assess nutrition status in hemodialysis patients in not clear based on one study. Based on one study ISRNM criteria was not able to predict mortality, however, further research is warranted.
- 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 the International Society of Renal Nutrition and Metabolism (ISRNM) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Malnutrition Inflammation Score (MIS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on validity studies, prediction studies and correlational studies, Malnutrition Inflammation Score (MIS) is a valid and reliable tool to assess nutritional status in patients on maintenance hemodialysis. Only one study reported use of MIS in transplant patients and showed positive correlation with inflammatory markers.
- 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 the Malnutrition Inflammation Score (MIS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Malnutrition Score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of malnutrition score to assess nutrition status in patients on hemodialysis in not clear based on one study. Based on one study malnutrition score is correlated with other nutrition status tools, however, further research is warranted.
- 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 the Malnutrition Score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Malnutrition Universal Screening Tool/Universal Screening Tool (MUST/MST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on two studies, evidence to support the use of Malnutrition Universal Screening Tool (MUST) and Malnutrition Screening Tool (MST) tools to assess nutritional status in patients on hemodialysis is not clear. The sensitivity to identify malnutrition is low, however, both are fairly reliable.
- 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 the Malnutrition Universal Screening Tool/Universal Screening Tool (MUST/MST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Mini Nutrition Assessment (MNA) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Based on validity and correlation studies, use of Mini-Nutrition Assessment (MNA) as a tool to assess nutrition status in patients on hemodialysis in not clear. Further research is warranted to understand the use of MNA and MNA-SF 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 the Mini Nutrition Assessment (MNA) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Nutrition Impact Symptom (NIS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of Nutrition Impact Symptoms (NIS) as a tool to assess nutrition status in patients on hemodialysis in not clear based on one study. Further research is warranted to understand the use of NIS 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 the Nutrition Impact Symptom (NIS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Nutrition Risk Score (NRS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of Nutrition Risk Score (NRS) as a tool to assess nutrition status in patients on hemodialysis in not clear based on one study. Based on one study NRS is a good predictor of mortality, however, further research is warranted.
- 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 the Nutrition Risk Score (NRS) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Nutrition Screening Tool (NST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of Nutrition Screening Tool (NST) as a tool to assess nutrition status in peritoneal dialysis patients in not clear based on 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 the Nutrition Screening Tool (NST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Bennett P, Breugelmans L, Meade A, Parkhurst D. A simple nutrition screening tool for hemodialysis nurses. Journal of Renal Nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation 2006; 16:59-62
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the PEW score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of protein energy wasting (PEW) score to assess nutrition status in patients on peritoneal dialysis (PD) or hemodialysis (HD) in not clear based on one study in each of these populations. Based on one study in patients on PD, PEW score did not predict mortality, whereas, PEW score was a predictor of survival in patients on HD. Further research is warranted to understand the use of PEW score 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 the PEW score for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Protein Nutrition Index (PNI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of Protein Nutrition Index (PNI) as a tool to assess nutrition status in peritoneal dialysis patients in not clear based on one study. Based on one study PNI is a good predictor of mortality, however, further research is warranted.
- 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 the Protein Nutrition Index (PNI) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Chen K, Wu C, Hsu C, Chen Y, Weng S, Yang C, Hung C. Protein nutrition index as a function of patient survival rate in peritoneal dialysis. Kidney & Blood Pressure Research 2010; 33:174-80
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)
Is there evidence to support the use of the Renal Nutrition Screening Tool (R-NST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
- Conclusion
  Use of the Renal Nutrition Screening (R-NST) tool as a tool to assess nutrition status in peritoneal dialysis patients in not clear based on 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 the Renal Nutrition Screening Tool (R-NST) for assessing nutritional status in adults with CKD 1-5D and post-transplant?
  - Detail
  - Quality Rating Summary
    For a summary of the Quality Rating results, click here.
  - Worksheets
    
    Xia YA, Healy A, Kruger R. Developing and Validating a Renal Nutrition Screening Tool to Effectively Identify Undernutrition Risk Among Renal Inpatients. Journal of Renal Nutrition 2016; :Epub ahead of print
- Search Plan and Results: CKD: Assessment: Composite Nutritional Indices (2018)