Fouque et al reported criteria for the diagnosis of protein-energy wasting (PEW) in patients with kidney disease. The authors are from multiple institutions in Europe and North America and the International Society of Renal Nutrition and metabolism (ISRNM).
Categories of protein-energy wasting in kidney disease:
(1) acute kidney injury
(2) chronic kidney disease
Features of protein-energy wasting:
(1) low concentrations of biochemical markers (albumin < 3.8 g/dL, transthyretin < 30 mg/dL, cholesterol < 100 mg/dL)
(2) reduced body weight (total body fat < 10%, BMI < 23 kg per square meter, unintentional weight loss > 5% over 3 months; unintentional weight loss > 10% over 6 months)
(3) sarcopenia (reduced muscle mass, reduced mid-arm muscle circumference)
(4) unintentional low protein or energy intake for at least 2 months
where:
• Transthyretin (prealbumin) levels apply to patients on maintenance dialysis. Serum levels in patients with chronic kidney disease stages 2-5 may vary with GFR.
Contributory factors:
(1) inadequate diet or dietary restrictions
(2) intercurrent catabolic illnesses
(3) nutrient losses during dialysis
(4) endocrine disorders (hyperglucagonemia, hyperparathyroidism, resistance to insulin, resistance to insulin-like growth factor-1, resistance to growth hormone)
(5) loss of blood (during dialysis, due to blood testing, etc)
(6) chronic inflammation with cytokine release
