Introduction
Cachexia/wasting or malnutrition in CKD
Characteristics | Malnutrition | Cachexia/PEW |
---|---|---|
Energy balance | − | − |
Appetite | ↑ | ↑ |
Metabolic rate | ↓ | ↓ |
Muscle mass | ≈ | ↓ |
Fat mass | ↓ | ≈ |
Response to calorie supplementation | + | − |
Clinical features and diagnostic criteria of cachexia/PEW in CKD
Criteria for PEW |
---|
Serum chemistry |
Serum albumin <3.8 g per 100 ml (Bromocresol Green)a
|
Serum prealbumin (transthyretin) <30 mg per 100 ml (for maintenance dialysis patients only; levels may vary according to GFR level for patients with CKD stages 2–5)a
|
Serum cholesterol <100 mg per 100 mla
|
Body mass |
BMI <23b
|
Unintentional weight loss over time: 5% over 3 months or 10% over 6 months |
Total body fat percentage <10% |
Muscle mass |
Muscle wasting: reduced muscle mass 5% over 3 months or 10% over 6 months |
Reduced mid-arm muscle circumference areac (reduction >10% in relation to 50th percentile of reference population) |
Creatinine appearanced
|
Dietary intake |
Unintentional low DPI <0.80 g kg−1 day−1 for at least 2 monthse for dialysis patients or <0.6 g kg−1 day−1 for patients with CKD stages 2–5 |
Unintentional low DEI <25 kcal kg−1 day−1 for at least 2 monthse
|