Table 1 | Criteria for clinical diagnosis of protein–energy wasting (PEW), from Fouque et al.,24 with the permission of Nature
Publishing
Criteria
Serum chemistry
Serum albumin o3.8 g/dl (Bromcresol Green)a
Serum prealbumin (transthyretin) o30 mg/dl (for maintenance dialysis patients only; levels may vary according to glomerular filtration rate level
for patients on CKD stages 2–5)a
Serum cholesterol o100 mg/dla
Body mass
BMI o23 kg/m2 b
Unintentional weight loss over time: 5% over 3 months or 10% over 6 months
Total body fat percentage o10%
Muscle mass
Muscle wasting: reduced muscle mass 5% over 3 months or 10% over 6 months
Reduced mid-arm muscle circumference areac (reduction 410% in relation to 50th percentile of reference population)
Creatinine appearanced
Dietary intake
Unintentional low-dietary protein intake o0.80 g/kg/day for at least 2 monthse for dialysis patients or o0.6 g/kg/day for patients on CKD stages 2–5
Unintentional low-dietary energy intake o25 kcal/kg/day for at least 2 monthse
Abbreviation: BMI, body mass index.
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 2–3 weeks apart.
aNot valid if low concentrations are due to abnormally great urinary or gastrointestinal protein losses, to liver disease or to cholesterol-lowering medicines.
bA lower BMI might be desirable for certain Asian populations; weight must be edema-free mass, for example, postdialysis dry weight. See text for the discussion about the
BMI of the healthy population.
cMeasurement must be performed by a trained anthropometrist.
dCreatinine appearance is influenced by both muscle mass and meat intake.
eCan 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 catabolic rate) as determined by urea kinetic measurements.