Background: There are multiple equations for predicting resting energy expenditure (REE), but how accurate they are in severe acute kidney injury (AKI) patients is not clear. Our aim was to determine if predictive equations for estimated REE accurately reflect the requirements of AKI patients. Methods: We included in this prospective and observational study AKI patients AKIN-3 assessed by indirect calorimetry (IC). Bland-Altman, intraclass correlation coefficient and precision (percentagem of predicted values within 10% of measured values) were performed to compare REE by equations with REE measured by IC. Results: IC was applied in 125 AKI patients. The mean age was 62.5 ± 16.6 and 65.6% were male. Mean REE measured was 2,029.11 ± 760.4 kcal/day. There were low precision, and poor agreement between measured and predicted REE by the Harris-Benedict (HB), Mifflin, Ireton-Jones, Penn state, American College of Chest Physicians, and Faisy equations. HB without using injury factor was the least precise (18% of precision). Modified Penn state equation had the best precision, although the precision rate was only 41%. For all equations, the limits of agreement range were large leading to the potential under or overfeeding of individual patients. Conclusion: None of these equations accurately estimated measured REE in severe AKI patients and most of them underestimated energy needs.

SancheS acS et al. 672rev assoC med bras 2016; 62(7):672-679 Patients on intensive care present systemic, metabolic, and hormonal alterations that may adversely affect their nutritional condition and lead to fast and important depletion of lean mass and malnutrition. Several factors and medical conditions can influence the energy expenditure (EE) of critically ill patients, such as age, gender, surgery, serious infections, medications, ventilation modality, and organ dysfunction. Clinical conditions that can present with EE change include acute kidney injury, a complex disorder commonly seen in critically ill patients with manifestations that can range from minimum elevations in serum creatinine to renal failure requiring dialysis. The nutritional needs of this population are therefore complex, and determining the resting energy expenditure is essential to adjust the nutritional supply and to plan a proper diet, ensuring that energy requirements are met and avoiding complications associated with overfeeding and underfeeding. Several evaluation methods of EE in this population have been described, but all of them have limitations. Such methods include direct calorimetry, doubly labeled water, indirect calorimetry (IC), various predictive equations, and, more recently, the rule of thumb (kcal/kg of body weight). Currently, IC is considered the gold standard.Keywords: energy expenditure, critically ill patient, energy requirement, indirect calorimetry.iMportance of deterMining energy expenditure in critically ill patients Adequate supply of nutrients is an essential part of the overall treatment of critically ill patients and adjustment of nutritional requirements to the individual needs of patients is a matter crucial to their clinical evolution, because both situations, overfeeding and underfeeding, may contribute to high morbidity and mortality in this population. 1,2 In such a context, an adequate assessment of energy expenditure (EE) is the basis of effective nutritional planning. 3 Total energy expenditure (TEE) is defined as the energy required by the body daily, determined by adding the following components: basal energy expenditure (BEE), diet--induced thermogenesis (DIT) and physical activity (PA). 4 BEE reflects the energy requirements to maintain the intracellular environment and mechanical processes such as respiration and cardiac function, as well as thermoregulatory mechanisms responsible for regulating the body temperature. 5,6 It is considered the main component in TEE, contributing 60 to 75% of the daily energy requirement for most sedentary individuals and approximately 50% for the physically active. BEE must be measured in thermoneutral conditions (20ºC) in the absence of recent nutrient administration (12 to 14 hours of fasting), recent physical activity (at least 8 hours of sleep), and psychological stress, while the subject is fully awake, lying in silence, completely relaxed and breathing normally.The energy corresponding to the thermal effect of food refers to the expenditure caused by dige...

The three evaluated modalities did not change REE. Indirect calorimetry can be performed during dialysis procedures and there was no difference between ventilation parameters, sedatives use, body temperature and VAD in both moments.

Variabilidade diária do gasto energético de repouso em pacientes com lesão renal aguda em tratamento dialítico Introdução: É imprescindível a correta estimativa do gasto energético de repouso (GER), que pode apresentar considerável variação diária no paciente crítico com lesão renal aguda (LRA). Objetivo: Avaliar a variabilidade diária do GER medido por calorimetria indireta (CI) em pacientes com LRA e indicação dialítica e identificar as variáveis clínicas associadas ao GER. Métodos: O GER foi medido no dia da indicação do procedimento dialítico e nos quatro dias subsequentes. Também foram avaliados parâmetros que podem influenciar o GER. As diferenças diárias foram analisadas pelo modelo linear generalizado para medidas repetidas, com distribuição gama, além da correlação de Spearman e regressão linear múltipla. Resultados: Foram 301 medidas de CI realizadas em 114 pacientes, com idade de 60,65 ± 16,9 anos e 68,4% do sexo masculino. O GER médio foi de 2081 ± 645 Kcal, com aumento no dia 5 (2270 ± 556 Kcal), quando comparado aos dias 2 e 3 (2022 ± 754; 2022 ± 660 kcal, respectivamente, p = 0,04); quando normalizado para peso, não houve diferença significante no GER (kcal/kg/dia) durante o acompanhamento. GER correlacionou-se positivamente com temperatura corporal, contagem total de leucócitos, proteína C reativa, volume minuto (VM), fração inspirada de oxigênio (FiO 2 ), aparecimento de nitrogênio ureico (UNA), peso corporal e estatura e inversamente com idade. Após a regressão linear múltipla, somente VM, FiO 2 e peso corporal e idade se correlacionaram independentemente. Conclusão: Pacientes com LRA dialíticos apresentam GER está-vel. O GER foi associado independentemente com FiO 2 , VM, peso e idade. Assim, requisitos ventilatórios precisam ser avaliados diariamente para que alterações necessárias na prescrição dietética sejam feitas. ResumoPalavras-chave: consumo de energia; lesão renal aguda; metabolismo energético. Introduction:It is needed for nutrition prescription correct estimate of resting energy expenditure (REE), which is a challenge given the possible daily variation in critically ill patients with acute kidney injury (AKI). Objective: To evaluate the daily variability of REE measured by indirect calorimetry (IC) in patients with AKI and dialysis indication and identify clinical variables associated with REE. Methods: The REE was measured on the time of dialysis indication and the subsequent four days. We also evaluated parameters that can influence the REE. The daily differences were analyzed by generalized linear model for repeated measures. We also used Spearman correlation and multiple linear regression. Results: There were 301 IC measurements in 114 patients, mean age of 60.65 ± 16.9 years and 68.4% were male. The average REE was 2081 ± 645 kcal, rising on day 5 (2270 ± 556 kcal) compared to the days 2 and 3 (2022 ± 754; 2022 ± 660 kcal, respectively, p = 0,04). When normalized to weight, there was no significant difference in REE (kcal/kg/day) during follow-up. REE was positively correlate...

Background: The determination of resting energy expenditure (REE) in critically ill patients could prevent complications such as hypo-and hyperalimentation. This study aims to describe the REE in septic patients with and without acute kidney injury (AKI) and compare the REE estimated by the Harris-Benedict equation (HB) with the REE measured by indirect calorimetry (IC). Methods: Prospective and observational study was performed. Septic patients older than 18 years, undergoing mechanical ventilation, with or without AKI defined by KDIGO criteria, and admitted to the Intensive Care Unit of University Hospital from Brazil were included. The REE was estimated by HB equation and measured by the IC within 72 h after the diagnosis of sepsis and 7 days after the initial measure. Results: Sixty-eight patients were evaluated, age was 62.5 ± 16.6 years, 64.7% were male, 63.2% had AKI, and SOFA was 9.8 ± 2.35. The measured REE was 1857.5 ± 685.32 kcal, while the estimated REE was 1514.8 ± 356.72 kcal, with adequacy of 123.5 ± 43%. Septic patients without AKI (n = 25) and with AKI (n = 43) had measured REE statistically higher than the estimated one Conclusions: The REE measured by IC was significantly higher than that estimated by HB equation in both septic with and without AKI. There was no significant difference in REE between the septic patients with and without AKI, suggesting that AKI does not influence the energy metabolism of septic patients.