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PEW Assessment CKD — ESENeph MCQ

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ModerateChronic Kidney DiseasePEW Assessment CKDESENeph

A 55-year-old man with CKD G3b and diabetes has a BMI of 22 and unintentional weight loss of 5 kg over 3 months. His albumin is 30 g/L and CRP is 12 mg/L. He has poor appetite. What nutritional concern is paramount?

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Correct answer: C — Protein-energy wasting – weight loss, hypoalbuminaemia, inflammation, and poor appetite in CKD indicate PEW; nutritional assessment and intervention are needed urgently

Unintentional weight loss with hypoalbuminaemia, inflammation, and anorexia in CKD is protein-energy wasting (PEW). Unlike obesity (which is common early in CKD), PEW develops in advanced CKD and is a strong predictor of mortality. Assessment should include dietary review, body composition (DEXA, bioimpedance), and inflammatory markers. Interventions include oral nutritional supplements, appetite stimulants (Megestrol – limited evidence), treating underlying inflammation, optimising dialysis (if applicable), and considering intradialytic parenteral nutrition for severe cases.

Reference: KDOQI 2020 – Nutrition in CKD; Fouque et al 2008 – PEW Consensus