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Nutrition in Clinical Practice
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Invited Reviews

Protein and Energy Depletion in Chronic Hemodialysis Patients: Clinical Applicability of Diagnostic Tools

M. A. Kamimura, MS*, K. M. Majchrzak, MS{dagger}, L. Cuppari, RD, PhD* and L. B. Pupim, MD, MSCI{dagger}

* Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil; and the{dagger} Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee

Correspondence: Lara B. Pupim, MD, Vanderbilt University Medical Center, 1161 21st Ave. South & Garland, Division of Nephrology, S-3223 MCN, Nashville, TN 37232-2372. Electronic mail may be sent to lara.pupim{at}vanderbilt.edu.

Protein and energy depletion states are common and associated with increased morbidity and mortality in chronic hemodialysis (CHD) patients. Therefore, proper use of diagnostic tools to assess depleted states in CHD patients is critical. Assessment of protein and energy status can be done by an array of methodologies that include simple estimates of the visceral and somatic pools of protein to more refined techniques to measure protein and energy balance. The nutritional and metabolic derangements in the CHD population are highly complex and can be confounded by multiple comorbidities and fluid shifts between body compartments. Therefore, assessment of protein and energy status in CHD patients requires a wide range of methodologies that not only identify depleted states but also monitor nutrition therapy and predict clinical outcome. Most important, these methods require cautious and individualized interpretation in order to minimize the interference of comorbid conditions frequently observed in the CHD population. Currently, there is not a single method that can be considered the gold standard for assessment of protein and energy status in CHD patients. Therefore, a combination of methods is recommended. In this review, we describe available methods to assess protein and energy status, with special considerations pertaining to CHD patients.

Nutrition in Clinical Practice, Vol. 20, No. 2, 162-175 (2005)
DOI: 10.1177/0115426505020002162
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