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Physical methods for evaluating the nutrition status of hemodialysis patients

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Abstract

This article aims to provide an overview of the different nutritional markers and the available methodologies for the physical assessment of nutrition status in hemodialysis patients, with special emphasis on early detection of protein energy wasting (PEW). Nutrition status assessment is made on the basis of anamnesis, physical examination, evaluation of nutrient intake, and on a selection of various screening/diagnostic methodologies. These methodologies can be subjective, e.g. the Subjective Global Assessment score (SGA), or objective in nature (e.g. bioimpedance analysis). In addition, certain biochemical tests may be employed (e.g. albumin, pre-albumin). The various subjective-based and objective methodologies provide different insights for the assessment of PEW, particularly regarding their propensity to differentiate between the important body composition compartments—fluid overload, fat mass and muscle mass. This review of currently available methods showed that no single approach and no single marker is able to detect alterations in nutrition status in a timely fashion and to follow such changes over time. The most clinically relevant approach presently appears to be the combination of the SGA method with the bioimpedance spectroscopy technique with physiological model and, additionally, laboratory tests for the detection of micro-nutrient deficiency.

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Conflict of interest

All authors are employees of Fresenius Medical Care and may hold stock in the company.

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This article does not contain any studies with human participants performed by any of the authors.

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Authors and Affiliations

  1. EMEALA Medical Board, Fresenius Medical Care, Else-Kroener-Strasse 1, 61352, Bad Homburg, Germany

    Daniele Marcelli, Aileen Grassmann & Bernard Canaud

  2. Global Research and Development, Fresenius Medical Care, Bad Homburg, Germany

    Peter Wabel & Sebastian Wieskotten

  3. Fluid and Nutrition Management, NephroCare, Naples, Italy

    Annalisa Ciotola

  4. Medical Direction, NephroCare, Naples, Italy

    Attilio Di Benedetto

Authors
  1. Daniele Marcelli
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  2. Peter Wabel
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  3. Sebastian Wieskotten
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  4. Annalisa Ciotola
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  5. Aileen Grassmann
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  6. Attilio Di Benedetto
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  7. Bernard Canaud
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Correspondence to Daniele Marcelli.

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Marcelli, D., Wabel, P., Wieskotten, S. et al. Physical methods for evaluating the nutrition status of hemodialysis patients. J Nephrol 28, 523–530 (2015). https://doi.org/10.1007/s40620-015-0189-x

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  • DOI: https://doi.org/10.1007/s40620-015-0189-x

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