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Comparative Standards for Assessing Weight (Renal)

Practice Consideration

Comparative Standards for Assessing Weight (Renal)
Weight for all stages of chronic kidney disease should be within normal weight ranges. The optimum weights derived from the following methods should be interpreted with caution, since with reduced kidney function the body's ability to regulate fluid increasingly impacts measured body weight.  Selecting the most appropriate comparative standard for body weight requires clinical judgment.
 
Name of Reference Standard Method of Calculation Resources
Desirable Body Weight Use Metropolitan Life Insurance Healthy Weight Tables
(Located on page 23 of Medical Impairments Guide available here)		 Chronic Kidney Disease Evidence-Based Nutrition Practice Guidelines — EAL

McCarthy, Pavlinac, and Aoun. Chronic Kidney Disease and the Nutrition Care Process. Academy of Nutrition and Dietetics; Chicago, IL. 2014.
HAMWI (Rule of Thumb) Quick formula
MEN: 106 lb for first 5 ft and 6 lb for every inch over 5 ft
WOMEN: 100 lb for first 5 ft and 5 lb for every inch over 60 inches		 Chronic Kidney Disease Evidence-Based Nutrition Practice Guidelines — EAL
Standard Body Weight Median body weight (50th percentile) for patients of same height, gender, frame size, and age from the National Health and Nutrition Examination Survey II data Chronic Kidney Disease Evidence-Based Nutrition Practice Guidelines — EAL

McCarthy, Pavlinac, and Aoun. Chronic Kidney Disease and the Nutrition Care Process. Academy of Nutrition and Dietetics; Chicago, IL. 2014.
Body Mass Index BMI should be within normal range of 18 to 25

It is recommended that the BMI of maintenance dialysis patients be maintained in the upper 50th percentile for normal individuals, which would mean a BMI for men and women no lower than approximately 23.6 to 24.0 kg/m2. This recommendation also appears appropriate for chronic kidney disease patients with significant GFR reductions (Stages 3 to 5)—see K/DOQI Nutrition Guideline, Appendix II
BMI of > 23 may be considered "ideal" body weight and used to generate estimated energy or protein requirements		 NHLBI BMI Tables 

Chronic Kidney Disease Evidence-Based Nutrition Practice Guidelines — EAL

K/DOQI Nutrition Guidelines

UK Renal Association-Nutrition in CKD Guidelines

Practice Based Evidence in Nutrition --PEN
Adjusted Body Weight Based on the theory that 25% of the excess body weight (adipose tissue) in obese patients is metabolically active tissue. KDOQI supports the concept of subtracting 25% for obese patients and adding 25% for underweight patients.  Chronic Kidney Disease Evidence-Based Nutrition Practice Guidelines — EAL

Adjusted Body Weight Tables

McCarthy, Pavlinac, and Aoun. Chronic Kidney Disease and the Nutrition Care Process. Academy of Nutrition and Dietetics; Chicago, IL. 2014.
Edema-Free Body Weight (efBW) or Dry Weight Used in Stage 5 patients. Estimated by dividing 142 mEq/L × Liters of Normal Total Body Water by Predialysis Serum Sodium (mEq/L)=Liters of Actual Body Weight

Normal Total Body Water
  • Normal weight — is 60% for males and 50% for females
  • Muscle wasting or Overweight — 57% for males and 47% for females
 McCarthy, Pavlinac, and Aoun.  Chronic Kidney Disease and the Nutrition Care Process.  Academy of Nutrition and Dietetics; Chicago, IL.  2014.  

Adjusted Estimated Edema Free Body Weight
 

 


References
1.  CKD: Executive Summary of Recommendations (2010), Evidence Based Nutrition Practice Guidelines.  Available at: www.andeal.org/topic.cfm?menu=5303&cat=3929. Accessed September 28, 2016.
2.  McCarthy, Pavlinac, and Aoun.  Chronic Kidney Disease and the Nutrition Care Process.  Academy of Nutrition and Dietetics; Chicago, IL.  2014.
Body Mass Index, Table 1.  Aim for a Healthy Weight, Education and Awareness.  Available at:  www.nhlbi.nih.gov/health/educational/.  Accessed September 28, 2016.
PART 6. ASSOCIATION OF LEVEL OF GFR WITH COMPLICATIONS IN ADULTS, KDOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification. Available at: www2.kidney.org/  Accessed September 28, 2016.
3.  Chan M, Patwardhan A, Ryan C, Trevillian P, Chadban S, Westgarth F, Fry K; Caring for Australasians with Renal Impairment; Dietitians Association of Australia. Journal of Renal Nutrition 2011;21(1):47-51
4.  Nutrition in CKD, Clinical Practice Guidelines UK Renal Association 5th Edition 2009-2010.  Available at: www.renal.org/  Accessed September 28, 2016.  
5.  Adjusted Body Weight From STD Tables, Available at: touchcalc.com/  Accessed September 28, 2016.
6.  KDOQI Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, NKF KDOQI Guidlines. Available at: www2.kidney.org/  Accessed September 28, 2016.
7.  Nephrology - Chronic Kidney Disease.  Practice Based Evidence in Nutrition (PEN).  Available at:  www.pennutrition.com/.  Accessed December 17, 2106 

 

Updated July 10, 2019
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