Application of mid-upper arm muscle circumference measurement in medical nutritional therapy for chronic kidney disease patients experiencing routine hemodialysis and experiencing malnutrition: A case report

Context: Chronic kidney disease (CKD) patients on routine hemodialysis are often diagnosed with protein-energy wasting (PEW). Medical nutritional therapy can be used to prevent PEW and improve the quality of life. Mid-upper arm muscle circumference is a reliable index to describe total body protein and muscle mass. In this study, four CKD patients and experiencing hemodialysis for about 6 weeks were monitored. Aims: To examine the benefit of medical nutritional therapy on mid-upper arm muscle circumference measurements in malnourished CKD patients experiencing routine hemodialysis. Methods: The observational method was used. Results: Two patients had a good appetite with their energy and protein intake exceeding 35 kcal/ideal BW and 1.5 g/ideal BW, respectively, during the initial assessment. The other two patients had respective values ranging from 20-25 kcal/ideal BW and 0.5-0.8 g/ideal BW. All patients had low upper arm muscle circumference indicating potential muscle depletion. During monitoring, the energy and protein intake increased in three patients, but decrease in protein intake but still met the target of 1.1-1.4 g/ideal BW/day. In line with the reference, all patients had MUAMC measurements below the 50th percentile, indicating malnutrition and decreased muscle mass. Two patients were diagnosed with PEW, while the remaining were found to be at risk. Conclusion: The assessment of malnutrition risk and implementation of adequate nutritional therapy in CKD patients experiencing routine hemodialysis should be prioritized to prevent the progression of PEW.