Criteria for diagnosis of kidney disease-related protein-energy wasting

Criteria

Serum chemistry

Serum albumin <3.8 g/dL (bromocresol green)*

Serum prealbumin (transthyretin) <30 mg/dL (for maintenance dialysis patients only; levels may vary according to GFR level for patients on CKD stages 2 to 5)*

Serum cholesterol <100 mg/dL*

Body mass

BMI <23 kg/m²^¶

Unintentional weight loss over time: 5% over three months or 10% over six months

Total body fat percentage <10%

Muscle mass

Muscle wasting: reduced muscle mass 5% over three months or 10% over six months

Reduced mid-arm muscle circumference area^Δ (reduction >10% in relation to 50^th percentile of reference population)

Creatinine appearance^◊

Dietary intake

Unintentional low-dietary protein intake <0.8 g/kg/day for at least two months^§ for dialysis patients or <0.6 g/kg/day for patients on CKD stages 2 to 5

Unintentional low-dietary energy intake <25 kcal/kg/day for at least two months^§

At least three out of the four listed categories (and at least one test in each of the selected categories) must be satisfied for the diagnosis of kidney disease-related PEW. Optimally, each criterion should be documented on at least three occasions, preferably two to three weeks apart.

GFR: glomerular filtration rate; CKD: chronic kidney disease; BMI: body mass index; PEW: protein-energy wasting.
* Not valid if low concentrations are due to abnormally great urinary or gastrointestinal protein losses, to liver disease, or to cholesterol-lowering medicines.
¶ A lower BMI might be desirable for certain Asian populations; weight must be edema-free mass, for example, postdialysis dry weight. Refer to UpToDate topic on assessment of nutritional status in dialysis patients for the discussion about the BMI of the healthy population.
Δ Measurement must be performed by a trained anthropometrist.
◊ Creatinine appearance is influenced by both muscle mass and meat intake.
§ Can be assessed by dietary diaries and interviews, or for protein intake by calculation of normalized protein equivalent of total nitrogen appearance (normalized protein nitrogen appearance or normalized protein catabolid rate) as determined by urea kinetic measurements.

Graphic 67264 Version 7.0

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Criteria for diagnosis of kidney disease-related protein-energy wasting