Validating Appetite Assessment Tools Among Patients Receiving Hemodialysis

Area of Science:

• Nephrology
• Clinical Nutrition
• Patient Assessment

Background:

• Appetite disturbances are common in patients undergoing hemodialysis (HD).
• Accurate assessment of appetite is crucial for nutritional management in HD patients.
• Existing appetite assessment tools have not been comprehensively evaluated in this population.

Purpose of the Study:

• To evaluate the performance of five different appetite assessment tools in patients receiving hemodialysis.
• To compare the ability of these tools to identify poor appetite, defined by low food intake.

Main Methods:

• A cross-sectional study involving 221 HD patients from seven Northern California dialysis facilities.
• Five appetite assessment tools were used: self-assessment, subjective assessment, Visual Analog Scale (VAS), Functional Assessment of Anorexia/Cachexia Therapy (FAACT) score, and Anorexia Questionnaire (AQ).
• Criterion measures included reported food intake, normalized protein catabolic rate, and body weight changes. Associations with nutritional and inflammatory biomarkers were assessed.

Main Results:

• 26% of patients reported poor appetite (food intake ≤ 50%).
• Prevalence of anorexia varied significantly across tools, ranging from 6% (subjective assessment) to 24% (VAS).
• The FAACT score and VAS demonstrated the strongest association with poor food intake (C-statistics 0.80 and 0.76, respectively). Patients with poor appetite reported more weight loss and less weight gain.

Conclusions:

• Different appetite assessment tools provide substantially different prevalence estimates for anorexia in HD patients.
• The FAACT score and VAS are recommended for assessing anorexia in HD patients, showing good discrimination based on self-reported food intake.
• Further research may refine the use of these tools for nutritional interventions in HD.