KDOQIGUIDELINE 9. ASSOCIATION OF LEVEL OF GFR WITH NUTRITIONAL STATUS.docVIP

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KDOQIGUIDELINE 9. ASSOCIATION OF LEVEL OF GFR WITH NUTRITIONAL STATUS.doc

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K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification PART 6. ASSOCIATION OF LEVEL OF GFR WITH COMPLICATIONS IN ADULTS GUIDELINE 9. ASSOCIATION OF LEVEL OF GFR WITH NUTRITIONAL STATUS Protein energy malnutrition develops during the course of chronic kidney disease and is associated with adverse outcomes. Low protein and calorie intake is an important cause of malnutrition in chronic kidney disease. Patients with GFR 60 mL/min/1.73 m2 should undergo assessment of dietary protein and energy intake and nutritional status—see K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure (CRF), Guidelines 23 and 26: Guideline 23. Panels of Nutritional Measures for Nondialyzed Patients: For individuals with CRF (GFR 20 mL/min) protein-energy nutritional status should be evaluated by serial measurements of a panel of markers including at least one value from each of the following clusters: (1) Serum albumin; (2) Edema-free actual body weight, percent standard (NHANES II) body weight, or subjective global assessment (SGA); and (3) Normalized protein nitrogen appearance (nPNA) or dietary interviews and diaries. (Evidence and Opinion) Guideline 26. Intensive Nutritional Counseling for Chronic Renal Failure: The nutritional status of individuals with CRF should be monitored at regular intervals. Patients with decreased dietary intake or malnutrition should undergo dietary modification, counseling, and education or specialized nutrition therapy—see K/DOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure (CRF), Guidelines 24 and 25: Guideline 24. Dietary Protein Intake for Nondialyzed Patients: For individuals with chronic renal failure (GFR 25 mL/min) who are not undergoing maintenance dialysis, the institution of a planned low-protein diet providing 0.60 g protein/kg/d should be considered. For individuals who will not accept such a diet or who are unable to maintain adequate dietary ener