Biochemical assessment of nutritional status

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Biochemical assessment offers the advantages of being readily available in most clinical settings, it is objective, and it requires only minimal patient cooperation. CKD and dialysis procedures each can influence nutritional status, limiting nutrient intake due to anorexia, dietary restrictions, socioeconomic constraints, or impaired gastrointestinal (GI) motility. In addition, CKD also exerts an indirect effect on nutritional status by increasing requirements and impairing the body's ability to down-regulate resting energy expenditure (REE) and protein turnover. Biochemical testing provides important insights into adequacy of protein and energy intake, the presence of inflammatory or oxidative stress, and nutritional adequacy over time.

The Kidney Disease Outcome Quality Initiative (KDOQI) nutrition practice guidelines recommended the use of a panel of nutritional parameters because no single index comprehensively summarizes all aspects of nutritional status (3). The KDOQI nutrition guidelines recommend a battery of anthropometric, clinical, and dietary assessments in addition to the biochemical parameters listed in Table 1. The work group divided nutritional markers into tests to be done routinely, confirmatory tests to be done as needed, and screening tests requiring further confirmation. In addition to providing data for assessment of protein-energy nutritional status, other biochemical parameters frequently are of importance in the dietary and medical management

Table 1

KDOQI Biochemical Testing Regimen in Stages 2-5 CKD (3)

Table 1

KDOQI Biochemical Testing Regimen in Stages 2-5 CKD (3)

Marker type

Marker

Measurement frequency

Routine

Predialysis serum albumin

Monthly in

maintenance

dialysis (every 1-3

months in CKD)

nPNA

Monthly (every

3-4 months for

peritoneal dialysis;

every 3-4 months

in CKD)

Confirmatory

Predialysis serum prealbumin

As needed

Screening

Predialysis serum creatinine

As needed

Predialysis serum cholesterol

As needed

Creatinine index

As needed

CKD, Chronic kidney disease; nPNA, normalized protein equivalent of nitrogen appearance.

CKD, Chronic kidney disease; nPNA, normalized protein equivalent of nitrogen appearance.

of patients receiving dialysis, such as glucose, glycated hemoglobin (A1C), potassium, phosphorus, and calcium, but are beyond the scope of this chapter.

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