Body composition and energy metabolism in chronic renal insufficiency

Abstract

Malnutrition and wasting are important determinants of morbidity and mortality in patients with chronic renal failure on dialysis. The aim of this study was to determine body composition and energy metabolism in patients with chronic renal insufficiency before dialysis. We compared 15 patients (9 women and 6 men) with chronic renal failure (creatinine, 1.5 to 4.2 mg/dL) with 15 normal subjects pair-matched for sex, age (renal failure versus normal, 71 +/- 3 years versus 64 +/- 3 years), height (1.61 +/- 0.02 m versus 1.64 +/- 0.02 m), and weight (64.5 +/- 2.7 kg versus 66.4 +/- 1.5 kg). Body composition was measured by dual-energy x-ray absorptiometry, and total body water was measured by bioelectrical impedance. Energy metabolism was determined by indirect calorimetry. The average glomerular filtration rate for the patients with chronic renal insufficiency was 23.9 +/- 2.6 mL/min/1.73 m2. Lean body mass (41.1 +/- 2.0 kg versus 44.5 +/- 2.2 kg; P = 0.003) and bone mineral content (2.35 +/- 0.11 kg versus 2.72 +/- 0.12 kg; P = 0.007) were significantly lower in chronic renal insufficiency; however, fat body mass was the same (19.9 +/- 2.1 kg versus 19.1 +/- 1.4 kg; P = 0.68). Total body water was similar in renal failure (33.4 +/- 1.5 L versus 34.4 +/- 1.3 L; P = 0.13). Basal energy expenditure was significantly lower in chronic renal insufficiency (1,085 +/- 50 kcal/24 hours versus 1,280 +/- 54 kcal/24 hours; P = 0.02), even after adjustment for the differences in lean body mass. Daily caloric intake indicated energy intake was similar in the patients with chronic renal insufficiency and the controls. Patients with a relatively modest degree of chronic renal insufficiency are characterized by reduced lean body mass, bone mineral content, and basal energy expenditure. The determinants of lean body mass in chronic renal insufficiency require further investigation.

Short-term effects of a very-low-protein diet supplemented with ketoacids in nondialyzed chronic kidney disease patients

“…In fact, Passey et al (2003) measuring the total energy expenditure and the dietary intake of predialysis patients following a conventional low protein diet found the majority of patients would meet their energy expenditure at 126 kJ/kg/day (30 kcal/kg/day) rather than the recommended 146 kJ/kg/day (35 kcal/kg/day). Moreover, some evidence for lower resting energy expenditure compared to healthy subjects has been recently demonstrated (O'Sullivan et al, 2002;Avesani et al, 2003). Additionally, in our study the maintenance of the nutritional status even with low energy intake could be the result of a higher protein intake as demonstrated by PNA.…”

Resting energy expenditure and its determinants in hemodialysis patients

“…Moreover, the profound abnormalities in cell metabolism that occur in renal failure (Om and Hohenegger, 1980) and the impaired energy metabolism of skeletal muscle caused by circulating uremic toxins (Conjard et al, 1995) may be additional factors contributing to reduce REE in renal failure patients. Accordingly, studies with CKD patients not yet on dialysis have recently demonstrated lower REE than healthy pair-matched controls (O'Sullivan et al, 2002;Avesani et al, 2004b). In HD patients evaluated in a nondialysis day, a recent study showed that protein breakdown and oxidation was considerably reduced compared with control subjects, suggesting lower metabolic activity in this patient group (Veeneman et al, 2004).…”

Estimativa das necessidades energéticas em pacientes com doença renal crônica

“…Posteriormente, trabalhos com objetivo semelhante, mas que empregaram metodologia mais adequada (grupos pareados por sexo e idade, e ajuste do GER pela massa corporal magra) mostraram resultados diferentes [15][16][17] . Na fase não dialí-tica da DRC, um estudo que avaliou o GER de indivíduos idosos (n=15, idade 60 anos) mostrou que ele se encontrava reduzido quando comparado ao de idosos saudáveis 17 .…”

“…Na fase não dialí-tica da DRC, um estudo que avaliou o GER de indivíduos idosos (n=15, idade 60 anos) mostrou que ele se encontrava reduzido quando comparado ao de idosos saudáveis 17 . Corroborando esse achado, Avesani et al 18 , ao analisarem o GER de indivíduos com DRC em tratamento conservador em uma amostra maior (n=45) e com idade mais abrangente (33 a 56 anos), também encontraram o mesmo resultado.…”