Evaluation of nutrition assessment tools compared with body cell mass for the assessment of malnutrition in chronic kidney disease

Abstract

Objective: To compare the Subjective Global Assessment (SGA) and a range of SGA-based
assessment tools with body cell mass in Stage IV and V pre-dialysis chronic kidney disease (CKD) patients.
Study design: Cross-sectional, observational.
Setting: Public tertiary hospital pre-dialysis outpatient clinic-----
Patients: A total of 56 consecutive consenting patients with CKD (61% were male; age [mean ± standard deviation] 70.2 ± 11.6 years; glomerular filtration rate 22.2 ± 6.8 mL/min).-----
Main Outcome measure: Nutrition status.
Results: In this population the prevalence of malnutrition was 19.6% (n=11, SGA B; no C ratings).
Malnutrition was associated with lower body cell mass (mean BCM, 26.3 vs. 33.4 kg p=0.007, measured by
total body potassium, TBK), body weight (64.8 vs. 76.1 kg p=0.042), BMI (23.7 vs. 27.6 kg/m2 p=0.015) and
greater weight loss over previous 6 months (-6.2 vs. -0.1 kg p=0.004). Body cell mass had a weak
relationship with 7-point SGA (p=0.267), malnutrition inflammation score (MIS r=-0.27 p=0.063) and patientgenerated
SGA (PG-SGA r=-0.27 p=0.060). There was no association for either measure of nutrition status
(SGA or BCM) with albumin, glomerular filtration rate or C-reactive protein.-----
Conclusion: SGA in its original form most accurately delineated malnutrition by depleted BCM and is the
most appropriate tool for cross-sectional assessment of nutrition status in predialysis CKD patients.