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Objective The study compared the 7-point Subjective Global Assessment (SGA) and the Protein Energy Wasting (PEW) Score with Nutrition Evaluations (NutrE) conducted by registered dietitian nutritionists (RDNs) in identifying PEW risk in stage five chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD). Design and Methods This study is a secondary analysis of a cross-sectional study entitled “Development and Validation of a Predictive energy Equation in Hemodialysis”. PEW risk identified by the 7-point SGA and the PEW Score were compared against the NutrE conducted by RDNs through data examination from the original study (reference standard). Subjects A total of 133 patients were included for the analysis. Main Outcome Measures The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) of both scoring tools were calculated when compared against the reference standard. Results The patients were predominately African American (n=112, 84.2%), non-Hispanic (n=101, 75.9%), and male (n=80, 60.2%). Both the 7-point SGA (sensitivity =78.6%, specificity = 59.1%, PPV = 33.9%, NPV = 91.2%, PLR = 1.9 and NLR = 0.4) and the PEW Score (sensitivity = 100%, specificity= 28.6%, PPV = 27.2%, NPV = 100%, PLR = 1.4 and NLR = 0) were more sensitive than specific in identifying PEW risk. The 7-point SGA may miss 21.4% patients having PEW and falsely identify 40.9% of patients who do not have PEW. The PEW Score can identify PEW risk in all patients but 71.4% of patients identified may not have PEW risk. Conclusions Both the 7-point SGA and the PEW Score could identify PEW risk. The 7-point SGA was more specific and the PEW Score was more sensitive. Both scoring tools were found to be clinically confident in identifying patients who were actually not at PEW risk.

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