Chart 1
Grading of Recommendations, Assessment, Development and Evaluation (GRADE)99 Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008 Apr;336(7650):924-6. Framework
Chart 2
Strength of recommendation
Recommendation 1
The Malnutrition Screening Tool (MST) should be used to screen patients with CKD at risk of malnutrition. Screening should be performed at least monthly.
Level of Evidence A, Strength 1
Chart 3
Malnutrition Screening Tool - MST
Recommendation 2
The Nutrition Care Process (NCP) and the Nutrition Care Process Terminology (NCPT) should be standardized for patients with CKD.
Level of evidence B, Strength 1
Recommendation 3
From a total of 1,041 internationally standardized terms in Nutrition Assessment and Reassessment, 107 should be included in the initial training program for nutritionists working with patients with CKD in Brazil.
Level of evidence C, Strength 1
Recommendation 4
From a total of 1,041 internationally standardized terms in Nutrition Assessment and Reassessment, 107 should be included in the initial training program for nutritionists working with patients with CKD in Brazil.
Level of evidence C, Strength
Table 1
Nutrition Assessment and Reassessment Terms deemed essential by nutritionists specialized in kidney disease
Recommendation 5
The definition of protein-energy malnutrition may be standardized for patients with CKD based on etiology and association with inflammation, as follows: 1) associated with chronic disease or condition with ongoing inflammation; 2) associated with chronic disease with minimal or undetected inflammation; 3) associated with acute disease or injury with severe inflammation; and 4) associated with chronic low food intake unrelated to the disease.
Level of evidence B, Strength 1
Table 2
Nutrition Diagnosis Terms deemed essential by nutritionists specialized in chronic kidney disease
Recommendation 6
The Subjective Global Assessment (SGA) is the best validated protein-energy malnutrition diagnostic tool for patients with CKD. The Malnutrition Clinical Characteristics (MCC) is an objective tool validated for different patient populations that may also be used with individuals with CKD.
Level of evidence A for the SGA and B for the MCC; Strength 1
Chart 4
Clinical characteristics of malnutrition in adults: Academy and ASPEN criteria
Recommendation 7
From a total of 385 internationally standardized terms in Nutrition Intervention, nine should be included in the initial training program for nutritionists working with patients with CKD in Brazil.
Level of evidence C, Strength 1
Table 3
Nutrition Intervention Terms deemed essential by nutritionists specialized in chronic kidney disease
Recommendation 8
The KDOQI Nutrition guidelines should be used as the standard reference for daily nutrient intake for patients with CKD. Tools My Plate, Mediterranean Diet Pyramid, and the DASH Diet may be recommended as references for food choices and may be adjusted to patients in various stages of CKD. Individual goals must be established based on professional judgment.
Level of evidence B, Strength 1
Chart 5
References for daily nutrient intake for patients with chronic kidney disease
Recommendation 9
From a total of 991 internationally standardized terms in Nutrition Monitoring and Evaluation, 94 should be included in the initial training program for nutritionists working with patients with CKD in Brazil
Level of evidence C, Strength 1
Recommendation 10
The acronym ADIME (Assessment, Diagnosis, Intervention, and Monitoring/Evaluation) should be used as a reference to document the Nutrition Care Process of patients with CKD.
Level of evidence C, Strength 1
Recommendation 11
Outcome management in malnutrition must split patients into age ranges. Other indicators directly related to nutrition interventions are interdialytic weight gain, phosphorus, calcium, 25-hydroxyvitamin D, potassium, serum bicarbonate and glucose, or glycosylated hemoglobin.
Level of evidence A, Strength 1
Chart 6
Quality management indicators recommended for nutrition care of patients with chronic kidney disease