Resting energy expenditure and its determinants in hemodialysis patients

Abstract

Objective: Chronic kidney disease is associated with several metabolic disturbances that can affect energy metabolism. As resting energy expenditure (REE) is scarcely investigated in patients on hemodialysis (HD) therapy, we aimed to evaluate the REE and its determinants in HD patients. Design: Cross-sectional study. Setting: Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. Subjects: The study included 55 patients (28 male, 41.4712.6 years old) undergoing HD therapy thrice weekly for at least 2 months, and 55 healthy individuals pair matched for age and gender. Subjects underwent fasting blood tests, as well as nutritional assessment, and the REE was assessed by indirect calorimetry. Results: REE of HD patients was similar to that of pair-matched controls (13797272 and 14407259 kcal/day, respectively), even when adjusted for fat-free mass (P ¼ 0.24). REE of HD patients correlated positively with fat-free mass (r ¼ 0.74; Po0.001) and body mass index (r ¼ 0.37; Po0.01), and negatively with dialysis adequacy (r ¼ À0.46; Po0.001). No significant univariate correlation was found between REE and age, dialysis vintage, serum creatinine, urea, albumin, bicarbonate, parathyroid hormone (PTH) or high-sensitivity C-reactive protein (CRP). In the multiple linear regression analysis, using REE as dependent variable, the final model showed that besides the well-recognized determinants of REE such as fat-free mass and age, PTH and CRP were the independent determinants of REE in HD patients (R 2 ¼ 0.64).

Estimativa das necessidades energéticas em pacientes com doença renal crônica

“…Trabalhos incluindo pacientes em diálise mostram resultados controversos. Ikizler et al 15 , ao avaliarem o GER de pacientes em Hemodiálise (HD), encontraram que esse índice era significantemente maior nesse grupo do que em controles saudáveis, enquanto outros dois trabalhos não mostraram diferenças entre os grupos 19,20 . Estes últimos achados, divergentes, podem ser explicados pela característica da amostra, composta por indivíduos de faixa etária inferior (de 28 a 54 anos e de 31 a 57 anos, respectivamente) e em condições clínicas está-veis 19,20 .…”

“…Monteon et al 13 Schneeweiss et al 14 Ikizler et al 15 Avesani et al 16 O´Sullivan et al 17 Ikizler et al 24 Cuppari et al 21 Wang et al 23 Avesani et al 18 Utaka et al 22 Kamimura et al 20 Kamimura et al 5 12 …”

Gasto energético de repouso em pacientes com doença renal crônica

“…Após uma década desde o primeiro estudo de GER, realizado por Monteon et al 46 , incluindo pacientes em hemodiálise, Ikizler et al 48 mostraram que durante a sessão de diálise e mesmo no período interdialítico o GER dos pacientes era significantemente maior que o de indiví-duos saudáveis (15% a 20% durante a diálise e 7,5% no período interdialítico). Em um estudo mais recente, em que 55 pacientes em hemodiálise foram emparelhados por sexo e idade com 55 indivíduos saudáveis, observou-se que o GER dos pacientes não diferia do grupo controle (1379, DP=272kcal/dia vs 1440, DP=259kcal/dia, respectivamente; p=0,11), mesmo ajustanto o GER pela massa magra 49 .…”

“…Mais recentemente, a influência da inflamação sobre o GER foi demonstrada também nos pacientes em hemodiálise. A proteína C-reativa e a interleucina-6 foram preditores independentes para o aumento do GER nessa população 49,55 .…”

Basal metabolic rate in children with chronic kidney disease and healthy control children

“…Therefore, a deeper appreciation of the factors that have been used to determine the EAR is required, including how these factors might alter with differences in disease pathology and treatment. Firstly, in CKD the use of energy in the basal statecaptured as resting energy expenditure (REE)-may be increased in response to inflammation, infection or hyperparathyroidism [6][7][8][9][10][11][12] or decreased as part of a reductive adaption to undernourishment. Only three full-text studies have been published on metabolic rate and children with CKD, with the evidence suggesting that metabolic rate in children with CKD is reduced compared to that in healthy controls when expressed in absolute terms [13,14], but unchanged when expressed per kilogram body weight or lean tissue [13] or when expressed against predictive values [15].…”