Evaluation of Nutritional Status in Patients with Kidney Disease: Usefulness of Dietary Recall Philippe Chauveau, MD,* Emmanuelle Grigaut, RD,* Anne Kolko, MD,† Patricia Wolff, RD,* Christian Combe, MD,* and Michel Aparicio, MD* Background: Three-day food recall and normalized protein nitrogen appearance calculation from pre- and postdialysis plasma urea are the most commonly used techniques to assess nutritional intake, but a 7-day dietary recall is probably more accurate to approach dietary intake in clinical practice. Methods: A total of 99 hemodialyzed patients from two units were analyzed in a 7-day dietary record with a large range of age and without having any signs of malnutrition. Dietary protein intake was estimated from the recall and calculated (normalized protein catabolic rate) from urea kinetic modeling. Calorie intake and quality and repartition of nutrients were estimated from diaries. Results: Repartition of nutrients was close to that of a reference population except for a lower glucidic contribution (glucide 47%, lipid 36%, protein 16%). Normalized protein catabolic rate and dietary protein intake were well correlated (R2 = 0.4), but a large variability existed from day to day, according to age (older patients are less variable) and day of dialysis (long or short interval). Conclusion: A large variation in alimentary intake exists from patient to patient and day to day. A 7-day evaluation of nutrient intake, dialysis adequacy, and nutritional parameters seems to be a good solution to guide dietetic counseling. © 2007 by the National Kidney Foundation, Inc. M ALNUTRITION, which is highly prev- alent in patients with kidney disease, is associated with poor clinical outcomes. 1 Malnu- trition is primarily caused by an inadequate bal- ance between lower dietary intake and higher needs. The first cause of lower nutrients intake is progressive anorexia, which is associated with the progression of renal failure. 2 Other causes worsen the decrease in nutritional intake, such as a large number of medications, gastropathy, psychosocial factors, infection, and inflammation. In patients on dialysis, despite the correction of numerous meta- bolic disorders related to chronic renal failure, the negative balance tends to worsen. Food intake de- creases in relation to inadequate dialysis, postdialysis fatigue, hypotension, dry mouth, and ageusia. The reduction in appetite is in relation to inflammation markers. 3 Poor appetite is also associated with a higher morbidity and mortality rate. 3 On the other hand, protein requirements are higher because of the loss in nutrients and amino acids, loss of protein in peritoneal dialysis, inflammation in relation to fluid or dialysate or bioincompatible membrane, infection of vascular access, and peritonitis. 4 As in the general population, the evaluation of nutritional status requires more than one marker. It is recommended to associate body composition assessment with biochemical markers and evalu- ation of food intake. 5 Associated with weight, height, and body mass index calculation, the assessment of body com- position could be easily performed by anthro- pometry and more accurately by bioelectrical impedance analysis, dual x-ray absorptiometry, or near-infrared reactance. Serum levels of albumin and prealbumin are the biochemical markers most often used to assess visceral protein stores, whereas changes in serum creatinine over time may indicate a change in *From the Département de Néphrologie et de Transplantation Rénale, Centre Hospitalier Universitaire, Bordeaux, France. †Service de Néphrologie, Hôpital Foch, Suresnes, France. Address reprint requests to Philippe Chauveau, MD, Départe- ment de Néphrologie, Hôpital Pellegrin, 33076 Bordeaux, France. E-mail: ph.chauveau@wanadoo.fr © 2007 by the National Kidney Foundation, Inc. 1051-2276/07/1701-0017$32.00/0 doi:10.1053/j.jrn.2006.10.015 Journal of Renal Nutrition, Vol 17, No 1 ( January), 2007: pp 88-92 88