title: A new approach to classifying malnutrition in the hemodialysis patient.
abstract: BACKGROUND
  Novel classification nomenclature defining the type of malnutrition by the root cause of the hypoalbuminenia has been developing in the literature since 1999. As the classification of malnutrition became more definite in the literature, the need to assess the type of malnutrition, thereby the root cause(s) and initiate appropriate intervention(s), has become apparent.
  
  
  METHODS
  In September 1999, San Diego Dialysis began a continuous quality improvement (CQI) project to assess the root causes of hypoalbuminemia for patients with serum albumin level <3.5 g/dL. An extensive review of the literature was conducted on the subject of malnutrition, inflammation, and the acute-phase reaction.
  
  
  RESULTS
  Two major groups of patients emerged: those consuming adequate protein and calories, yet presenting with hypoalbuminemia, and those suffering from a protein calorie deficit. Observation of the second group showed that although the monthly percentage of patients with hypoalbuminemia remained fairly constant, the names on the list changed from month to month.
  
  
  CONCLUSIONS
  The CQI team developed a protocol and a unique nomenclature to classify the types of malnutrition, type I, type IIa, type IIb, or mixed, by adapting the definitions in the literature through clinical practice. Interventions were developed to address each classification of malnutrition.
authors.affiliation: San Diego Dialysis-National City, National City, CA, USA.
authors.forename: Aura
authors.initials: A
authors.lastname: O'keefe
authors.forename: Nancy W
authors.initials: NW
authors.lastname: Daigle
mesh_terms: D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000209:etiology*; D007249:Inflammation / Q000097:blood / Q000150:complications; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications* / Q000628:therapy; D009748:Nutrition Disorders / Q000145:classification*; D011502:Protein-Energy Malnutrition / Q000097:blood / Q000209:etiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012709:Serum Albumin / Q000032:analysis; D017749:Total Quality Management
chemical_list: D015415:Biomarkers; D004044:Dietary Proteins; D012709:Serum Albumin; D002097:C-Reactive Protein