How often should routine nutrition screening be done in adults with Chronic Kidney Disease (CKD) stages 3-5D?

Routine Nutrition Screening Frequency in CKD 3-5D

According to the 2020 KDOQI Guidelines, routine nutrition screening should be performed at least biannually (every 6 months) in adults with CKD stages 3-5D to identify those at risk of protein-energy wasting. 1

Screening vs. Comprehensive Assessment

It is critical to distinguish between nutrition screening and comprehensive nutrition assessment, as they serve different purposes and occur at different intervals:

Nutrition Screening

• Frequency: At least every 6 months (biannually) 1
• Purpose: To identify patients at risk of protein-energy wasting (PEW) 1
• Who performs it: Can be performed by various healthcare team members 1
• Tool selection: No single screening tool is superior to others based on current evidence 1

Comprehensive Nutrition Assessment

• Frequency: Different from screening 1
  • Within first 90 days of starting dialysis 1
  • Annually thereafter 1
  • When indicated by positive nutrition screening 1
  • When referred by provider 1
• Who performs it: Registered dietitian nutritionist (RDN) or international equivalent 1
• Components: Appetite, dietary intake history, body weight and BMI, biochemical data, anthropometric measurements, and nutrition-focused physical findings 1

Body Weight and BMI Monitoring

Beyond formal nutrition screening, body weight and BMI should be monitored more frequently based on CKD stage 1:

• CKD Stage 3: At least every 6 months 1
• CKD Stages 4-5 (not on dialysis): At least every 3 months 1
• CKD Stage 5D (on hemodialysis or peritoneal dialysis): At least monthly 1

Common Pitfalls to Avoid

Do not confuse screening frequency with assessment frequency. Screening is a brief, regular check (every 6 months) to flag at-risk patients, while comprehensive assessment is an in-depth evaluation by a dietitian that occurs less frequently but at critical time points 1.

Do not delay screening until symptoms of malnutrition are obvious. The biannual screening interval is designed to catch protein-energy wasting risk before it becomes clinically severe 1.

Do not rely solely on BMI for screening. While BMI should be monitored regularly, it alone is insufficient to diagnose PEW unless extremely low (<18 kg/m²) 1.

Integration with Medical Nutrition Therapy

When screening identifies patients at risk, they should receive medical nutrition therapy (MNT) from an RDN working in collaboration with physicians or other providers 1. The RDN should then 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 1.