Estimation of nutritional risk

Malnutrition and protein-energy wasting (PEW) affect most dialysis patients at some stage in their life; KDOQI 2020 recommends routine nutritional assessment using validated screening tools at initial evaluation, quarterly, and after clinical changes to guide dietetic therapy and prevent adverse outcomes.

Body Mass Index

The Body Mass Index or BMI is derived from body weight and height and was designed to provide a measure of weight independent of height.

It can be calculated by the tool below.

BMI CALCULATOR

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{{a.name}}
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clear Clear calculate Calculate
-- BMI

Percentage of Weight Loss

Weight loss is indicative of insufficient energy intake. Therefore the % of weight loss has been associated with nutritional status and clinical outcomes. An unintentional weight loss equal to 5% of the usual body weight is alerting and a weight loss ≥ 10% of the usual body weight is considered clinically significant and has been associated with increased mortality and morbidity.

WEIGHT LOSS CALCULATOR

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clear Clear calculate Calculate
-- Weight Loss Weight Gain

Nutritional screening tools – Hospitalised (Renal iNUT)
(Jackson et al., 2019)

In hospitalized CKD/dialysis patients, Renal iNUT provides rapid risk stratification via weight and intake changes along with having an awareness if patients are already on nutritional supplements.

Renal inpatient NUTRITION SCREENING TOOL - iNUT

keyboard_double_arrow_right Start the Tool
Renal inpatient NUTRITION SCREENING TOOL clear
Total Score {{totalScore()}} point{{totalScore() == 1 ? '':'s'}}
navigation
play_circle GET STARTED
STEP 1 - Screening type Please select the type of screening
Type of screening Admission screening Weekly screening
Is the patient on dialysis? Yes No
STEP 2 - BMI calculation Please fill the fields and calculate BMI value
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clear Clear calculate Calculate
-- BMI
STEP 3 - Screening questions Please answer the questions
{{bmiResult}} kg/m² BMI
Has the patient unintentionally lost weight from their target weight? No Yes
Does the patient look malnourished OR has a BMI of 20 kg/m² or less? No Yes
Is the patient already on nutritional supplements (e.g.Fortisip / Nepro)? No Yes
Compared to usual, how is the patient‘s food intake? Better/Similar Worse
Compared to usual, how is the patient‘s appetite? Better/Similar Worse
Has the patient unintentionally lost weight from their usual weight? No Yes
Does the patient look malnourished OR has a BMI of 20 kg/m² or less? No Yes
Is the patient already on nutritional supplements (e.g.Fortisip / Nepro)? No Yes
Compared to usual, how is the patient‘s food intake? Better/Similar Worse
Compared to usual, how is the patient‘s appetite? Better/Similar Worse
Has the patient lost 3 kg or more since admission? No Yes
Does the patient look malnourished OR has a BMI of 20 kg/m² or less? No Yes
Compared to last week, how is the patient‘s food intake? Better/Similar Worse
Compared to last week, how is the patient‘s appetite? Better/Similar Worse
RESULT Final score {{totalScore()}} point{{totalScore() == 1 ? '':'s'}}
{{(totalScore() < 1) ? 'YOUR RESULT':''}}
LOW RISK

Action plan

  • Continue with weekly screening
{{(totalScore() == 1) ? 'YOUR RESULT':''}}
At RISK

Action plan

  • Continue with weekly screening
  • Assist with eating & drinking if needed
  • Use a food record chart if needed
{{(totalScore() > 1) ? 'YOUR RESULT':''}}
HIGH RISK

Action plan

  • Refer the patient to the dietitian
  • Start a food chart and red tray
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Download Renal inpatient NUTRITION SCREENING TOOL (INUT) in PDF here.

Nutritional screening tools – Community (MUST)
(Stratton et al., 2004)

MUST evaluate BMI, weight loss, and acute illness in outpatient hemodialysis settings.

MALNUTRITION UNIVERSAL SCREENING TOOL - MUST

‘MUST’ is a three-step screening tool to identify adults, who are malnourished, at risk of malnutrition (undernutrition), or obese. It also includes management guidelines which can be used to develop a care plan. It is for use in hospitals, community and other care settings and can be used by all healthcare workers.

The Malnutrition Universal Screening Tool (MUST) is easy and straightforeward to perform and usually needs less than 3 minutes to complete.

keyboard_double_arrow_right Start the Tool
MALNUTRITION UNIVERSAL SCREENING clear

Works to advance the nutritional care of patients and those at risk from malnutrition in the wider community.

Total Score {{totalScore()}} point{{totalScore() == 1 ? '':'s'}}
navigation
play_circle GET STARTED
STEP 1 - BMI Please fill in the Patient BMI Score which was generated from the BMI Calculator Tool included in this Application
Your BMI kg/m2 > 20 (> 30 Obese) 18.5 – 20 < 18.5
STEP 2 - Weight Loss Please fill in the Patient weight loss which was generated from the Weight Loss Calculator Tool included in this Application
< 5% 5% – 10% > 10%
STEP 3 - Establish Acute Disease effect Please fill in the acute disease effect status of the patient.
If the patient is acutely ill and there has been or is likely to be no nutritional intake for >5 days, please select red option.
If not, please choose green option.
No disease effect Patient is acutely ill. No nutritional intake for > 5 days
RESULT Final score {{totalScore()}} point{{totalScore() == 1 ? '':'s'}}
{{(totalScore() < 1) ? 'YOUR RESULT':''}}
LOW RISK
Routine clinical care

Repeat screening

  • Hospital - weekly
  • Care Homes - monthly
  • Community - annually for special groups e.g. those >75 years

All risk categories

Treat underlying condition and provide help and advice on food choices, eating and drinking when necessary.

Record malnutrition risk category.

Record need for special diets and follow local policy.

Obesity

Record presence of obesity. For those with underlying conditions, these are generally controlled before the treatment of obesity.

{{(totalScore() == 1) ? 'YOUR RESULT':''}}
MEDIUM RISK
Observe

Document dietary intake for 3 days

If adequate - little concern and repeat screening

  • Hospital - weekly
  • Care Home - at least monthly
  • Community - at least every 2-3 months

All risk categories

Treat underlying condition and provide help and advice on food choices, eating and drinking when necessary.

Record malnutrition risk category.

Obesity

Record presence of obesity. For those with underlying conditions, these are generally controlled before the treatment of obesity.

{{(totalScore() > 1) ? 'YOUR RESULT':''}}
HIGH RISK
Treat *

Refer to dietetian, Nutritional Support team or implement local policy

Set goals, improve and increase overall nutritional intake

  • Hospital - weekly
  • Care Home - monthly
  • Community - monthly

*) Unless detrimental or no benefit is expected from nutritional support e.g. imminent death.

All risk categories

Treat underlying condition and provide help and advice on food choices, eating and drinking when necessary.

Record malnutrition risk category.

Obesity

Record presence of obesity. For those with underlying conditions, these are generally controlled before the treatment of obesity.

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‘MUST’ is reproduced here with the kind permission of BAPEN (British Association for Parenteral and Enteral Nutrition).
For further information on ‘MUST’ see www.bapen.org.uk Copyright © BAPEN 2012
(licence number LIC2206)

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