Nutritional Assessmentscreening

Kidney Function Restoration Program

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Ideally the nutritional status of patients approaching ESRF and starting dialysis should be monitored. As a single marker of nutritional status is unreliable, a number of nutritional parameters, as outlined in Chapter 14, can help identify those who are malnourished. Dual-energy X-ray absorptometry remains a useful method for assessment of lean body mass (15).

Nutrition scores such as subjective global nutrition assessment (SGA), based on clinical, physical and subjective measures are useful tools. The SGA is considered better suited to assessing study populations.

Serial biochemical flow charts are useful in assessing nutritional status (see Table 15.3). A decline in pre-dialysis serum urea, creatinine, potassium and phosphate may be indicative of a loss of lean body mass, rather than an improvement in nutritional status (17). Additional points to consider in the nutritional assessment of dialysis patients are given in Table 15.2.

Table 15.2 Additional factors in the nutritional assessment of dialysis patients

Factors

Comment

Anthropometry

Ensure measurements are taken at patient's dry weight:

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