Subjective Global Assessment (SGA)
SGA score is currently, commonly used as a valid and reliable nutritional status indicator in practice (Steiber et al., 2007). SGA is approved as a high applicable method to assess nutritional status with PEW in haemodialysis patients (Vegine et al., 2011). SGA scoring assess and grade into three degree on each contains which are weight include weight change, dietary intake and its change, gastrointestinal symptoms, functional capacity and its change, subcutaneous fat on three points of the body, muscle wasting on eight points of the body, oedema and ascites. However, a cohort study showed that malnutrition was not diagnosed in any patients when measured ...view middle of the document...
A recent study showed that lower than 1 g/kg/day of nPCR level associates with higher risk of mortality after 3 months of dialysis treatment. They also claimed that over 0.2 g/kg/day of decline in nPCR was seen as a portent of higher mortality. Furthermore, when serum nPCR level increased more than 0.2 g/kg/day after 21 months of dialysis treatment, it may suggest an occurrence of PEW (Lukowsky, Kheifets, Arah, Nissenson, & Kalantar-Zadeh, 2013).
Guidelines for dialysis treatment from several expert groups state that to sustain around 1.2 g/kg/day of protein intake in stable dialysis patients is recommended (Cano et al., 2006, Kopple, 2001).
Geriatric Nutritional Risk Index (GNRI)
GNRI is a nutrition associated risk indicator using albumin level, weight, and ideal weight calculated by height and sex for identify risk of morbidity and mortality among hospitalised elderly patients (Bouillanne et al., 2005). This indicator is simplified evidenced as a strong nutritional status predictor in haemodialysis patients (Kobayashi et al., 2010).
There are a few studies has been done to determine whether muscle strength can be used as a indicator of malnutrition status in chronic kidney disease as they lose muscle mass due to protein energy wasting. Leal, Mafra, Fouque, and Anjos (2011) suggested that hand grip strength is valid method to estimate muscle mass regarding continuous and systematic nutritional assessment among dialysis patients in practice.
A study which involved 115 patients who are close to the introduce of dialysis treatment showed that hand grip strength was strongly associated with lean body mass in both men and women. In this study, DXA and anthropometric measurements resulted similar mean values. Moreover, lean body mass was underestimated by CK in compared with DXA and anthropometric measurements. In addition, they found that independent factors of malnutrition, which are weak hand grip strength, low proportion of fat mass, female, and high serum CRP levels. This study also showed that serum albumin level did not have association with hand grip strength and lean body mass though, serum albumin level and C-reactive protein level and creatinine clearance were significantly related (Heimbürger, Qureshi, Blaner, Berglund, & Stenvinkel, 2000). Based on these points, measuring muscle mass seems to be valuable to identify patients who are invisibly establishing protein energy wasting.
Specific nutrients supplementation or medication trials had been done to discover effective treatment for haemodialysis patients in previous researches. As PEW is established from several causes, symptomatic treatment may be the direct therapy. Caso & Garlick, (2005) suggested that correcting acidosis may have a key role to maintain muscle mass. Furthermore, acidosis also associates insulin resistance that it was significantly improved when ESRD patients were supplied oral bicarbonate doses (Mak, 1998a). Insulin resistance...