Diagnosing malnutrition in patients on dialysis using the global leadership initiative on malnutrition (GLIM) criteria: bridging the gap between theoretical consensus and real-world applicability.

OBJECTIVES

The Global Leadership Initiative on Malnutrition (GLIM) is a framework for diagnosing malnutrition. The applicability of GLIM in patients receiving dialysis remains insufficiently explored. This study aimed to identify the most prevalent phenotypic criteria, assess whether dialysis per se can be used as the sole etiological criterion, and evaluate dietitians' perceptions of GLIM's feasibility in clinical practice.

METHODS

In this exploratory mix-method study, adult patients undergoing hemodialysis (HD) or peritoneal dialysis (PD) were recruited from six Swedish dialysis centers. Malnutrition was diagnosed and graded according to GLIM. Phenotypic criteria included unintentional weight loss, low body mass index, and low muscle mass assessed by calf or arm muscle circumference. Two etiologic models were applied: (I) reduced dietary intake or inflammation, and (II) dialysis as the sole disease-related burden. Renal dietitians conducted assessments and completed a questionnaire on feasibility.

RESULTS

Ninety-three patients were included (HD n = 57, PD n = 36), median age 74 y; 60% were male and 43% had diabetes. Low muscle mass was the most prevalent phenotypic criterion (49%). Malnutrition prevalence was 42% using model I and 55% using model II. Ten dietitians completed the assessments, with a median time of 15 minutes. Facilitators included clear guidelines, appropriate equipment, and organizational support. Assessment was also perceived as motivating for patients.

CONCLUSIONS

The prevalence of malnutrition among dialysis patients using GLIM varied between 42% and 55% depending on the etiological model. Low muscle mass was the most common phenotypic criterion. GLIM appeared feasible for routine use in dialysis care.