Journal of Renal Nutrition
Volume 14, Issue 1 , Pages 6-19 , January 2004

Assessment and monitoring of uremic malnutrition

  • Lara B Pupim, MD, MSCI

      Affiliations

    • Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  • ,
  • T.Alp Ikizler, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to T. Alp Ikizler, MD, Vanderbilt University Medical Center 1161 21st Ave. South & Garland, Division of Nephrology, S-3223 MCN, Nashville, TN 37232-2372, USA
    • Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee, USA

References 

  1. Young GA, Swanepoel CR, Croft MR, et al.  Anthropometry and plasma valine, amino acids, and proteins in the nutritional assessment of hemodialysis patients. Kidney Int. 1982;21:492–499
  2. Wolfson M, Strong CJ, Minturn RD, et al.  Nutritional status and lymphocyte function in maintenance hemodialysis patients. Am J Clin Nutr. 1984;37:547–555
  3. Hakim RM, Levin N. Malnutrition in hemodialysis patients. Am J Kidney Dis. 1993;21:125–137
  4. Lowrie EG, Huang WH, Lew NL, et al.  The relative contribution of measured variables to death risk among hemodialysis patients. In:  Friedman EA editors. Death on Hemodialysis. Amsterdam: Kluwer Academic Publishers; 1994;p. 121–141
  5. Pupim LB, Cuppari L. Malnutrition in end-stage renal disease (beyond inadequate nutrient intake). Nephrol News Issues. 2003;17:66–71
  6. Mitch WE. Insights into the abnormalities of chronic renal disease attributed to malnutrition. J Am Soc Nephrol. 2002;13(Suppl 1):S22–S27
  7. Sardesai VM. Fundamentals of nutrition. In:  Dekker M editors. Introduction to Clinical Nutrition. New York: Sardesai, V.M; 1998;p. 1–13
  8. Jeejeebhoy KN. Nutritional assessment. Nutrition. 2000;16:585–590
  9. Lowrie EG, Lew NL. Death risk in hemodialysis patients (The predictive value of commonly measured variables and an evaluation of death rate differences between facilities). Am J Kidney Dis. 1990;15:458–482
  10. Jeejeebhoy KN. Nutritional assessment. Gastroenterol Clin North Am. 1998;27:347–369
  11. Klein S. The myth of serum albumin as a measure of nutritional status. Gastroenterology. 1990;99:1845–1846
  12. Kirsch R, Frith L, Black E, et al.  Regulation of albumin synthesis and catabolism by alteration of dietary protein. Nature. 1968;217:578–579
  13. Fleck A, Raines G, Hawker F, et al.  Increased vascular permeability (A major cause of hypoalbuminaemia in disease and injury). Lancet. 1985;1:781–784
  14. Kaysen GA, Dubin JA, Muller HG, et al.  Relationships among inflammation nutrition and physiologic mechanisms establishing albumin levels in hemodialysis patients. Kidney Int. 2002;61:2240–2249
  15. Kaysen GA. Albumin turnover in renal disease. Miner Electrolyte Metab. 1998;24:55–63
  16. Kaysen GA. The microinflammatory state in uremia (Causes and potential consequences). J Am Soc Nephrol. 2001;12:1549–1557
  17. Kaysen GA, Rathore V, Shearer GC, et al.  Mechanisms of hypoalbuminemia in hemodialysis patients. Kidney Int. 1995;48:510–516
  18. Moshage HJ, Janssen JA, Franssen JH, et al.  Study of the molecular mechanism of decreased liver synthesis of albumin in inflammation. J Clin Invest. 1987;79:1635–1641
  19. Kaysen GA. Role of inflammation and its treatment in ESRD patients. Blood Purif. 2002;20:70–80
  20. Kaysen GA, Levin NW. Why measure serum albumin levels?. J Ren Nutr. 2002;12:148–150
  21. Beck FK, Rosenthal TC. Prealbumin (A marker for nutritional evaluation). Am Fam Physician. 2002;65:1575–1578
  22. Neyra NR, Hakim RM, Shyr Y, et al.  Serum transferrin and serum prealbumin are early predictors of serum albumin in chronic hemodialysis patients. J Ren Nutr. 2000;10:184–190
  23. Chertow GM, Ackert K, Lew NL, et al.  Prealbumin is as important as albumin in the nutritional assessment of hemodialysis patients. Kidney Int. 2000;58:2512–2517
  24. Spiekerman AM. Nutritional assessment (protein nutriture). Anal Chem. 1995;67:429R–436R
  25. Spiekerman AM. Proteins used in nutritional assessment. Clin Lab Med. 1993;13:353–369
  26. Mears E. Outcomes of continuous process improvement of a nutritional care program incorporating serum prealbumin measurements. Nutrition. 1996;12:479–484
  27. Group PiNCC . Measurement of visceral protein status in assessing protein and energy malnutrition: Standard of care. Prealbumin in Nutritional Care Consensus Group. Nutrition. 1995;11:169–171
  28. Staley MJ. Fructosamine and protein concentrations in serum. Clin Chem. 1987;33:2326–2327
  29. Oppenheimer JH, Werner SC. Effect of prednisone on thyroxine-binding proteins. J Clin Endocrinol Metab. 1966;26:715–721
  30. Le Moullac B, Gouache P, Bleiberg-Daniel F. Regulation of hepatic transthyretin messenger RNA levels during moderate protein and food restriction in rats. J Nutr. 1992;122:864–870
  31. Winkler MF, Gerrior SA, Pomp A, et al.  Use of retinol-binding protein and prealbumin as indicators of the response to nutrition therapy. J Am Diet Assoc. 1989;89:684–687
  32. Hedlund JU, Hansson LO, Ortqvist AB. Hypoalbuminemia in hospitalized patients with community-acquired pneumonia. Arch Intern Med. 1995;155:1438–1442
  33. Nieken J, Mulder NH, Buter J, et al.  Recombinant human interleukin-6 induces a rapid and reversible anemia in cancer patients. Blood. 1995;86:900–905
  34. O’Riordain MG, Ross JA, Fearon KC, et al.  Insulin and counterregulatory hormones influence acute-phase protein production in human hepatocytes. Am J Physiol. 1995;269:E323–E330
  35. Ingenbleek Y, Van Den Schrieck HG, De Nayer P, De Visscher M. Albumin, transferrin and the thyroxine-binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition. Clin Chim Acta. 1975;63:61–67
  36. Mittman N, Avram MM, Oo KK, et al.  Serum prealbumin predicts survival in hemodialysis and peritoneal dialysis (10 years of prospective observation). Am J Kidney Dis. 2001;38:1358–1364
  37. Duggan A, Huffman FG. Validation of serum transthyretin (prealbumin) as a nutritional parameter in hemodialysis patients. J Ren Nutr. 1998;8:142–149
  38. Huebers HA, Finch CA. The physiology of transferrin and transferrin receptors. Physiol Rev. 1987;67:520–582
  39. Fletcher JP, Little JM, Guest PK. A comparison of serum transferrin and serum albumin as nutritional parameters. J Parenter Enteral Nutr. 1987;11:144
  40. Taylor SJ, Fettes SB, Jewkes C, et al.  Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med. 1999;27:2525–2531
  41. Qureshi AR, Alvestrand A, Danielsson A, et al.  Factors predicting malnutrition in hemodialysis patients (A cross-sectional study). Kidney Int. 1998;53:773–782
  42. Barany P, Peterson E, Ahlberg M, et al.  Nutritional assessment in anemic hemodialysis patients treated with recombinant human erythropoietin. Clin Nephrol. 1991;35:270–279
  43. Roza AM, Tuitt D, Shizgal HM. Transferrin (A poor measure of nutritional status). J Parenter Enteral Nutr. 1984;8:523
  44. Kopple JD. National kidney foundation K/DOQI clinical practice guidelines for nutrition in chronic renal failure. Am J Kidney Dis. 2001;37:S66–S70
  45. Cano N, Di Costanzo-Dufetel J, Calaf R, et al.  Prealbumin-retinol-binding-protein-retinol complex in hemodialysis patients. Am J Clin Nutr. 1988;47:664–667
  46. Raynaud-Simon A, Perin L, Meaume S, et al.  IGF-I, IGF-I-binding proteins and GH-binding protein in malnourished elderly patients with inflammation receiving refeeding therapy. Eur J Endocrinol. 2002;146:657–665
  47. Van den Berghe GH. Acute and prolonged critical illness are two distinct neuroendocrine paradigms. Verh K Acad Geneeskd Belg. 1998;60:487–518 (discussion 519–520)
  48. Kiess W, Kessler U, Schmitt S, et al.  Growth hormone and insulin-like growth factor 1 (Basic aspects). In:  Flyvbjerg A,  Orskov H,  Alberti KG editor. Growth Hormone and INsulin-like Growth Factor 1. New York: Wiley; 1993;p. 1–21
  49. Jacob V, Carpentier JEL, Salzano S, et al.  IGF-1, a marker of undernutrition in hemodialysis patients. Am J Clin Nutr. 1990;52:39–44
  50. Kagan A, Altman Y, Zadik Z, et al.  Insulin-like growth factor-I in patients on CAPD and hemodialysis (Relationship to body weight and albumin level). Adv Perit Dial. 1995;11:234–238
  51. Parker TF, Wingard RL, Husni L, et al.  Effect of the membrane biocompatibility on nutritional parameters in chronic hemodialysis patients. Kidney Int. 1996;49:551–556
  52. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med. 1999;340:448–454
  53. Ikizler TA, Hakim RM. Nutrition in end-stage renal disease. Kidney Int. 1996;50:343–357
  54. Jelliffe DB, Jelliffe EF. An evaluation of upper arm measurements used in nutritional assessment. Am J Clin Nutr. 1980;33:2058–2059
  55. Frisancho AR. Anthropometric standards for the assessment of growth and nutritional status. Ann Arbor, MI: The University of Michigan Press; 1990;
  56. Nelson EE, Hong CD, Pesce AL, et al.  Anthropometric norms for the dialysis population. Am J Kidney Dis. 1990;16:32–37
  57. Gray GE, Gray LK. Validity of anthropometric norms used in the assessment of hospitalized patients. JPEN J Parenter Enteral Nutr. 1979;3:366–368
  58. Hall JC, O’Quigley J, Giles GR, et al.  Upper limb anthropometry (The value of measurement variance studies). Am J Clin Nutr. 1980;33:1846–1851
  59. Pollock ML, Jackson AS. Research progress in validation of clinical methods of assessing body composition. Med Sci Sports Exerc. 1984;16:606–615
  60. Evans EM, Arngrimsson SA, Cureton KJ. Body composition estimates from multicomponent models using BIA to determine body water. Med Sci Sports Exerc. 2001;33:839–842
  61. Chertow GM, Lazarus JM, Lew NL, et al.  Bioimpedance norms for the hemodialysis population. Kidney Int. 1997;52:1617–1621
  62. Flakoll PJ, Kent P, Neyra R, et al.  Bioelectrical impedance versus air displacement plethysmography and dual-energy x-ray absorptiometry to determine body composition in patients with end stage renal disease. JPEN J Parenter Enteral Nutr. 2004; (in press)
  63. Chertow GM. Estimates of body composition as intermediate outcome variables (Are DEXA and BIA ready for prime time?). J Ren Nutr. 1999;9:138–141
  64. Pupim LB, Kent P, Ikizler TA. Bioelectrical impedance analysis in dialysis patients. Miner Electrolyte Metab. 1999;25:400–406
  65. Dumler F, Kilates C. Use of bioelectrical impedance techniques for monitoring nutritional status in patients on maintenance dialysis. J Ren Nutr. 2000;10:116–124
  66. Woodrow G, Oldroyd B, Turney JH, et al.  Measurement of total body water by bioelectrical impedance in chronic renal failure. Eur J Clin Nutr. 1996;50:676–681
  67. Panotopoulos G, Ruiz JC, Guy-Grand B, et al.  Dual x-ray absorptiometry, bioelectrical impedance, and near infrared interactance in obese women. Med Sci Sports Exerc. 2001;33:665–670
  68. Wang J, Thornton JC, Kolesnik S, et al.  Anthropometry in body composition (An overview). Ann N Y Acad Sci. 2000;904:317–326
  69. Dumler F. Use of bioelectric impedance analysis and dual-energy X-ray absorptiometry for monitoring the nutritional status of dialysis patients. Asaio J. 1997;43:256–260
  70. Fogelholm M, van Marken Lichtenbelt W. Comparison of body composition methods (A literature analysis). Eur J Clin Nutr. 1997;51:495–503
  71. Kyle UG, Genton L, Pichard C. Body composition (what’s new?). Curr Opin Clin Nutr Metab Care. 2002;5:427–433
  72. Elia M. Assessment of nutritional status and body composition Clinical Nutrition Enteral and Tube Feeding. In:  Rombeau JL,  Rolandelli RH editor. ed 3. Philadelphia: Saunders; 1997;p. 155–173
  73. Kalantar-Zadeh K, Dunne E, Nixon K, et al.  Near infra-red interactance for nutritional assessment of dialysis patients. Nephrol Dial Transplant. 1999;14:169–175
  74. Dempster P, Aitkens S. A new air displacement method for the determination of human body composition. Med Sci Sports Exerc. 1995;27:1692–1697
  75. Levenhagen DK, Borel MJ, Welch DC, et al.  A comparison of air displacement plethysmography with three other techniques to determine body fat in healthy adults. JPEN J Parenter Enteral Nutr. 1999;23:293–299
  76. Fields DA, Goran MI, McCrory MA. Body-composition assessment via air-displacement plethysmography in adults and children (A review). Am J Clin Nutr. 2002;75:453–467
  77. Biaggi RR, Vollman MW, Nies MA, et al.  Comparison of air-displacement plethysmography with hydrostatic weighing and bioelectrical impedance analysis for the assessment of body composition in healthy adults. Am J Clin Nutr. 1999;69:898–903
  78. Keshaviah PR, Nolph KD, Moore HL, et al.  Lean body mass estimation by creatinine kinetics. J Am Soc Nephrol. 1994;4:1475–1485
  79. Lukaski HC. Methods for the assessment of human body composition (Traditional and new). Am J Clin Nutr. 1987;46:537–556
  80. Cohn SH, Brennan BL, Yasumura S, et al.  Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation. Am J Clin Nutr. 1983;38:52–58
  81. Stall S, DeVita MV, Ginsberg NS, et al.  Body composition assessed by neutron activation analysis in dialysis patients. Ann N Y Acad Sci. 2000;904:558–563
  82. Morgan WD. Of mermaids and mountains. Three decades of prompt activation in vivo. Ann N Y Acad Sci. 2000;904:128–133
  83. Kotler DP, Tierney AR, Wang J, et al.  Magnitude of body-cell-mass depletion and the timing of death from wasting in AIDS. Am J Clin Nutr. 1989;50:444–447
  84. Halliday AW, Benjamin IS, Blumgart LH. Nutritional risk factors in major hepatobiliary surgery. JPEN J Parenter Enteral Nutr. 1988;12:43–48
  85. Lehr K, Schober O, Hundeshagen H, et al.  Total body potassium depletion and the need for preoperative nutritional support in Crohn’s disease. Ann Surg. 1982;196:709–714
  86. Mann MD, Bowie MD, Hansen JD. Total body potassium and serum electrolyte concentrations in protein energy malnutrition. S Afr Med J. 1975;49:76–78
  87. Pollock CA, Ibels LS, Allen BJ, et al.  Total body nitrogen as a prognostic marker in maintenance dialysis. J Am Soc Nephrol. 1995;6:82–88
  88. Park JH, Olsen NJ. Utility of magnetic resonance imaging in the evaluation of patients with inflammatory myopathies. Curr Rheumatol Rep. 2001;3:334–345
  89. Forbes GB. Body composition. In:  Ziegler EE,  Filer LJ editor. Present Knowledge in Nutrition. (ed 7). Washington, DC: International Life Sciences Institutes Press; 1996;p. 7–12
  90. Baker JP, Detsky AS, Wesson DE, et al.  Nutritional assessment (A comparison of clinical judgment and objective measurements). N Engl J Med. 1982;306:969–972
  91. Detsky AS, McLaughlin JR, Baker JP, et al.  What is subjective global assessment of nutritional status?. JPEN J Parenter Enteral Nutr. 1987;11:8–13
  92. McCann L. Using subjective global assessment to identify malnutrition in the ESRD patient. Nephrol News Issues. 1999;13:18–19
  93. Detsky AS, Baker JP, Mendelson RA, et al.  Evaluating the accuracy of nutritional assessment techniques applied to hospitalized patients (methodology and comparisons). JPEN J Parenter Enteral Nutr. 1984;8:153–159
  94. Duerksen DR, Yeo TA, Siemens JL, et al.  The validity and reproducibility of clinical assessment of nutritional status in the elderly. Nutrition. 2000;16:740–744
  95. Caglar K, Fedje L, Dimmitt R, et al.  Therapeutic effects of oral nutritional supplementation during hemodialysis. Kidney Int. 2002;62:1054–1059
  96. Cooper BA, Bartlett LH, Aslani A, et al.  Validity of subjective global assessment as a nutritional marker in end-stage renal disease. Am J Kidney Dis. 2002;40:126–132
  97. Kalantar-Zadeh K, Kleiner M, Dunne E, et al.  A modified quantitative subjective global assessment of nutrition for dialysis patients. Nephrol Dial Transplant. 1999;14:1732–1738
  98. Kalantar-Zadeh K, Kopple JD, Block G, et al.  A malnutrition-inflammation score is correlated with morbidity and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2001;38:1251–1263
  99. Rao M, Sharma M, Juneja R, et al.  Calculated nitrogen balance in hemodialysis patients (Influence of protein intake). Kidney Int. 2000;58:336–345
  100. Goldstein DJ. Assessment of nutritional status in renal diseases. In:  Mitch WE,  Klahr S editor. Handbook of Nutrition and the Kidney. (ed 3). Philadelphia: Lippincott-Raven; 1998;p. 46–86
  101. Kopple JD, Coburn JW. Metabolic studies of low protein diets in uremia. I. Nitrogen and potassium. Medicine (Baltimore). 1973;52:583–595
  102. Kopple JD. Uses and limitations of the balance technique. JPEN J Parenter Enteral Nutr. 1987;11:79S–85S
  103. Reifenstein EC, Albright F, Wells SL. The accumulation, interpretation, and presentation of data pertaining to metabolic balances, notably those of calcium, phosphorus, and nitrogen. J Clin Endocrinol Metab. 1945;5:367–395
  104. Calloway DH. Nitrogen balance of men with marginal intakes of protein and energy. J Nutr. 1975;105:914–923
  105. Garlick PJ, Clugston GA, Swick RW, et al.  Diurnal variations in protein metabolism in man. Proc Nutr Soc. 1978;37:33A
  106. Garlick PJ, McNurlan MA, McHardy KC, Calder AG, Milne E, Fearns LM, et al. Rates of nutrient utilization in man measured by combined respiratory gas analysis and stable isotopic labeling (Effect of food intake). Hum Nutr Clin Nutr. 1987;41:177–191
  107. Barrett EJ, Revkin JH, Young LH, et al.  An isotopic method for measurement of muscle protein synthesis and degradation in vivo. Biochem J. 1987;245:223–228
  108. Wolfe RR. Radioactive and Stable Isotope Tracers in Biomedicine. New York: Wiley-Liss; 1992;
  109. Gelfand RA, Barrett EJ. Effect of physiologic hyperinsulinemia on skeletal muscle protein synthesis and breakdown in man. J Clin Invest. 1987;80:1–6
  110. Christensen HN. Role of amino acid transport and countertransport in nutrition and metabolism. Physiol Rev. 1990;70:43–77
  111. Shotwell MA, Kilberg MS, Oxender DL. The regulation of neutral amino acid transport in mammalian cells. Biochim Biophys Acta. 1983;737:267–284
  112. Biolo G, Zhang XJ, Wolfe RR. Role of membrane transport in interorgan amino acid flow between muscle and small intestine. Metabolism. 1995;44:719–724
  113. Biolo G, Fleming RY, Maggi SP, et al.  Transmembrane transport and intracellular kinetics of amino acids in human skeletal muscle. Am J Physiol. 1995;268:E75–E84
  114. Lim VS, Bier DM, Flanigan MJ, et al.  The effect of hemodialysis on protein metabolism (A leucine kinetic study). J Clin Invest. 1993;91:2429–2436
  115. Ikizler TA, Pupim LB, Brouillette JR, et al.  Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab. 2002;282:E107–E116
  116. Goodship TH, Mitch WE, Hoerr RA, et al.  Adaptation to low-protein diets in renal failure (Leucine turnover and nitrogen balance). J Am Soc Nephrol. 1990;1:66–75
  117. Goodship TH, Lloyd S, Clague MB, et al.  Whole body leucine turnover and nutritional status in continuous ambulatory peritoneal dialysis. Clin Sci (Lond). 1987;73:463–469
  118. Pupim LB, Flakoll PJ, Brouillette JR, et al.  Intradialytic parenteral nutrition improves protein and energy homeostasis in chronic hemodialysis patients. J Clin Invest. 2002;110:483–492
  119. Caglar K, Peng Y, Pupim LB, et al.  Inflammatory signals associated with hemodialysis. Kidney Int. 2002;62:1408–1416
  120. Kaysen GA, Dubin JA, Muller HG, et al.  Impact of albumin synthesis rate and the acute phase response in the dual regulation of fibrinogen levels in hemodialysis patients. Kidney Int. 2003;63:315–322
  121. Sardesai VM. Requirements for energy, carbohydrates, fat, and proteins. In:  Dekker M editors. Introduction to Clinical Nutrition. New York: Sardesai, V.M; 1998;p. 1–13
  122. Woo R, Daniels-Kush R, Horton ES. Regulation of energy balance. Annu Rev Nutr. 1985;5:411–433
  123. Bursztein S, Elwyn DH, Asakanazi J, et al.  Energy Metabolism, Indirect Calorimetry, and Nutrition. Baltimore: Williams & Wilkins; 1989;
  124. Ferrannini E, Elia M, Ravussin E, et al.  Indirect calorimetry (Theory and practice). In:  Kinney JM,  Tucker HN editor. Energy Metabolism. New York: Raven; 1992;p. 1–113
  125. Simonson DC, DeFronzo RA. Indirect calorimetry (Methodological and interpretative problems). Am J Physiol. 1990;258:E399–E412
  126. Jequier E, Acheson K, Schutz Y. Assessment of energy expenditure and fuel utilization in man. Annu Rev Nutr. 1987;7:187–208
  127. Leff ML, Hill JO, Yates AA, et al.  Resting metabolic rate (Measurement reliability). JPEN J Parenter Enteral Nutr. 1987;11:354–359

PII: S1051-2276(03)00180-8

doi: 10.1053/j.jrn.2003.10.001

Journal of Renal Nutrition
Volume 14, Issue 1 , Pages 6-19 , January 2004