Resting energy expenditure in pre‐dialysis diabetic patients

Avesani, Carla María; Cuppari, Lílian; Silva, Antonio Carlos da; Sigulem, Dirce Maria; Cendoroglo, Miguel; Sesso, Ricardo; Draibe, Sérgio Antônio

doi:10.1093/ndt/16.3.556

Cited by 67 publications

(45 citation statements)

References 26 publications

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“…However, in a study comprising 24 CKD diabetic patients and 24 CKD nondiabetic patients, the resting energy expenditure (64387963 and 560571318 kJ/day (15387230 and 13397315 kcal/day), respectively) was very similar to the energy intake estimated by 4-day food records (608671515 and 611671754 kJ/day (14547362 and 14617419 kcal/day), respectively). As the body mass index was indicative of overweight (26.874.7 and 25.873.8 kg/m 2 , respectively), this result suggests some degree of underestimation of energy intake (Avesani et al, 2001). Protein intake was indeed underestimated in the present study.…”

Section: Discussionsupporting

confidence: 42%

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

et al. 2004

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Objective: To evaluate the effects on the nutritional and metabolic parameters of a very-low-protein diet supplemented with ketoacids (VLPD þ KA) in comparison with a conventional low-protein diet (LPD) in chronic kidney disease (CKD) patients. Design: Prospective, randomized, controlled clinical study. Setting: Outpatient Clinic of the Nephrology Division of Federal University of São Paulo, Brazil. Subjects: The study involved 24 patients with advanced CKD (creatinine clearance o25 ml/min) that were randomly assigned to either a VLPD þ KA (VLPD þ KA group, 12 patients) or to a conventional LPD with 0.6 g/kg/day (LPD group, 12 patients). The patients were followed for 4 months. Results: Nutritional status was adequately maintained with both diets for the studied period. Protein intake and serum urea nitrogen decreased significantly only in the VLPD þ KA group (from 0.6870.17 to 0.4370.12 g/kg/day, Po0.05; from 61.4712.8 to 43.6714.9 mg/dl, Po0.001; respectively). Ionized calcium did not change in the VLPD þ KA group but tended to decrease in the LPD group. Serum phosphorus tended to decrease in the VLPD þ KA group probably as a result of a significant reduction in dietary phosphorus (5297109 to 3737125 mg/day, Po0.05) associated to the phosphorus-binding effect of the ketoacids. No change in these parameters was found in the LPD group. Serum parathormone increased significantly only in the LPD group (from 2417138 to 4947390 pg/ml, Po0.01). The change in PTH concentration was negatively correlated with changes in ionized calcium concentration (r ¼ À0.75, P ¼ 0.02) and positively correlated with changes in serum phosphorus (r ¼ 0.71, P ¼ 0.03) only in the LPD group. Conclusion: This study indicates that a VLPD þ KA can maintain the nutritional status of the patients similarly to a conventional LPD. Besides, an improvement in calcium and phosphorus metabolism and a reduction in serum urea nitrogen were attained only with the VLPD þ KA. Thus, VLPD þ KA can constitute another efficient therapeutic alternative in the treatment of CKD patients. Sponsorship: This study was supported by CAPES, Oswaldo Ramos Foundation and Fresenius Kabi, Ltda.

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Section: Discussionsupporting

confidence: 42%

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

et al. 2004

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“…Uremia per se and the dialysis procedure are associated with some metabolic derangements such as metabolic acidosis, insulin resistance and inflammation, that augment protein catabolism (Mitch et al, 1999) and could in turn contribute to the variations of REE. Accordingly, it has been shown that nondialysis CKD patients with poorly controlled diabetes (Avesani et al, 2001) and HD patients with severe hyperparathyroidism have increased REE. Inflammation is a highly prevalent condition among CKD patients.…”

Section: Introductionmentioning

confidence: 99%

Resting energy expenditure and its determinants in hemodialysis patients

et al. 2006

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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).

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“…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 .…”

Section: Gasto Energético De Repouso Na Doença Renal Crônicaunclassified

“…Ao compilar trabalhos que avaliaram o papel de comorbidades (diabetes Mellitus, hiperparatireoidismo secundário e condição inflamatória crônica) sobre o GER, observou-se que ele, nessas condições, encontrava-se aumentado em cerca de 12% a 23% 5,16,[21][22][23] . Vale mencionar ainda que o próprio procedimento de HD também é capaz de aumentar o gasto energético.…”

Section: Gasto Energético De Repouso Na Doença Renal Crônicaunclassified

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Estimativa das necessidades energéticas em pacientes com doença renal crônica

Rodrigues¹,

Lamarca²,

Oliveira

et al. 2013

Rev. Nutr.

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Estabelecer as necessidades energéticas de pacientes com doença renal crônica é importante para que se possam tratar os distúrbios nutricionais encontrados nessa população. Segundo os guias de condutas voltados ao cuidado nutricional de pacientes com essa doença, a recomendação energética pode variar entre 30 e 40kcal/kg/dia. Contudo, trabalhos que avaliaram os componentes do gasto energético nos pacientes com doença renal crônica sugerem que as necessidades energéticas dessa população podem diferir do valor recomendado acima, a depender da condição clínica (presença de comorbidades), da modalidade de tratamento empregado e do nível de atividade física. Dessa forma, o presente trabalho tem como objetivo fazer uma revisão dos estudos sobre o gasto energético de pacientes com doença renal crônica, com o intuito de abordar as seguintes questões: (1) as atuais recomendações de energia para pacientes com doença renal crônica estão adequadas? (2) qual equação de predição poderia ser empregada para estimar as necessidades energéticas desse grupo de pacientes? Assim, esta revisão busca auxiliar o nutricionista ao estimar as necessidades energéticas de pacientes com doença renal crônica.Palavras-chave: Doença renal crônica. Metabolismo energético. Necessidade energética. A B S T R A C TEstimating the energy requirement of patients with chronic kidney disease is highly important for treating the nutritional disorders often seen in this population. According to the specific guidelines for patients with chronic kidney disease, the currently recommended daily energy intake varies from 30 to 40kcal/kg/day. However,

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Resting energy expenditure in pre‐dialysis diabetic patients

Abstract: Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.

Cited by 67 publications

References 26 publications

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

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

Resting energy expenditure and its determinants in hemodialysis patients

Estimativa das necessidades energéticas em pacientes com doença renal crônica

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