Methods for assessing nutritional status of patients with renal failure

Abstract

Since wasting and malnutrition are common problems in patients with renal failure, it is important to develop techniques for the longitudinal assessment of nutritional status. This paper reviews available methods for assessing the nutritional status; their possible limitations when applied to uremic patients are discussed. If carefully done, dietary intake can be estimated by recall interviews augmented with dietary diaries. Also, in a stable patient with chronic renal failure, the serum urea nitrogen (N)/creatinine ratio and the rate of urea N appearance reflect dietary protein intake. A comparison of N intake and urea N appearance will give an estimate of N balance. Anthropometric parameters such as the relationship between height and weight, thickness of subcutaneous skinfolds, and midarm muscle circumference are simple methods for evaluating body composition. Other methods for assessing body composition, such as densitometry and total body potassium, may not be readily applicable in patients with renal failure. More traditional biochemical estimates of nutritional status such as serum protein, albumin, transferrin, and selected serum complement determinations show that abnormalities are common among uremic patients. Certain anthropometric and biochemical measurements of nutritional status are abnormal in chronically uremic patients who appear to be particularly robust; thus, factors other than altered nutritional intake may lead to abnormal parameters in such patients. Serial monitoring of selected nutritional parameters in the same individual may improve the sensitivity of these measurements to detect changes. Standards for measuring nutritional status are needed for patients with renal failure so that realistic goals can be established optimal body nutriture.

Association of genetic variants of ghrelin, leptin and UCP2 with malnutrition inflammation syndrome and survival in end-stage renal disease patients

“…Nutritional assessment was done using SGA scores (CANUSA 1996;Blumenkrantz et al 1980). SGA scoring was done on the basis of weight change in last 6 months, dietary intake (solid, semi-solid, liquid, starvation), gastrointestinal symptoms (nausea, anorexia, vomit, diarrhea), functional impairment, physical examination (loss of subcutaneous fat, muscle wasting and edema).…”

Estado nutricional de pacientes com insuficiência renal crônica em hemodiálise no Amazonas

“…No presente estudo, a albumina não se comportou como um marcador de desnutrição. Outros autores também observaram a baixa sensibilidade da albumina para detectar desnutrição 8 .…”

“…Diversos fatores podem ser responsáveis pela desnutrição nesses pacientes, entre eles a anorexia com conseqüente redução do consumo alimentar tem sido apontada como uma das principais causas 6,7,8 . Além disso, outras condições como distúrbios gastrointestinais, acidose metabólica, fatores associados ao procedimento dialítico, distúrbios hormonais, doenças associadas ou intercorrentes (diabetes mellitus, insuficiência cardíaca e infecções) podem também contribuir na fisiopatogênese dessa desnutrição 9 .…”

Abnormalities of bioimpedance measures in overweight and obese hemodialyzed patients

“…On the other hand, clinical and laboratory parameters are easy to collect but imprecise. 11,42 The main biochemical parameters suggestive of protein-energy malnutrition in dialysis, such as serum albumin, dietary protein intake (indicated by the protein equivalent of total nitrogen appearance or PCR) and predialysis serum urea nitrogen correlate with morbidity or mortality, 4,5,11 these markers, however, must be interpreted with caution and, more important, alterations of such indexes often become manifest only late in the course of the deteriorating nutritional status in dialysis, that is, after severe malnutrition is established. 6,11,12 Bioelectrical impedance analysis (BIA) allows a fast and sensitive bedside assessment of human body composition.…”