Nutrition Screening and Assessment in CKD 3-5D

Screening Frequency and Purpose

The Kidney Disease Outcomes Quality Initiative (KDOQI) recommends routine nutrition screening at least every 6 months in adults with CKD stages 3-5D to identify those at risk of protein-energy wasting 1
Nutrition screening serves the purpose of identifying patients at risk of protein-energy wasting (PEW) and can be performed by various healthcare team members 1

The KDOQI guidelines suggest that comprehensive nutrition assessment should be performed within the first 90 days of starting dialysis, annually thereafter, when indicated by positive nutrition screening, or when referred by a provider 4, 5
Comprehensive nutrition assessment should be performed by a registered dietitian nutritionist (RDN) or international equivalent and includes components such as appetite, dietary intake history, body weight and BMI, biochemical data, anthropometric measurements, and nutrition-focused physical findings 4, 5

Body weight and BMI should be monitored at least every 6 months for CKD Stage 3, at least every 3 months for CKD Stages 4-5 (not on dialysis), and at least monthly for CKD Stage 5D (on hemodialysis or peritoneal dialysis) 1, 4, 5

Patients at risk of protein-energy wasting identified through screening should receive medical nutrition therapy (MNT) from an RDN working in collaboration with physicians or other providers 6, 7, 8
The RDN should monitor and evaluate the effectiveness of MNT interventions through ongoing assessment of appetite, dietary intake, body weight changes, biochemical data, anthropometric measurements, and nutrition-focused physical findings 7, 8