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  • Original Article
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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, 41.4±12.6 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 (1379±272 and 1440±259 kcal/day, respectively), even when adjusted for fat-free mass (P=0.24). REE of HD patients correlated positively with fat-free mass (r=0.74; P<0.001) and body mass index (r=0.37; P<0.01), and negatively with dialysis adequacy (r=−0.46; P<0.001). 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 (R2=0.64).

Conclusions:

In this study, the REE of HD patients was similar to that of healthy individuals, even with the positive effect of secondary hyperparathyroidism and inflammation on REE of these patients.

Sponsorship:

The study was supported by grants from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) and Oswaldo Ramos Foundation.

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References

  • Avesani CM, Cuppari L, Silva AC, Sigulem DM, Cendoroglo M, Cesso R et al (2001). Resting energy expenditure in pre-dialysis diabetic patients. Nephrol Dial Transplant 16, 556–560.

    Article  CAS  Google Scholar 

  • Avesani CM, Draibe SA, Kamimura MA, Colugnati FAB, Cuppari L (2004a). Resting energy expenditure of chronic kidney disease patients: influence of renal function and subclinical inflammation. Am J Kidney Dis 44, 1008–1016.

    Article  Google Scholar 

  • Avesani CM, Draibe SA, Kamimura MA, Dalboni MA, Colugnati FA, Cuppari L (2004b). Decreased resting energy expenditure in non-dialyzed chronic kidney disease patients. Nephrol Dial Transplant 19, 3091–3097.

    Article  Google Scholar 

  • Baczynski R, Massry SG, Magott M, El-Belbessi S, Kohan R, Brautbar N (1985). Effect of parathyroid hormone on energy metabolism of skeletal muscle. Kidney Int 28, 722–727.

    Article  CAS  Google Scholar 

  • Chioléro R, Revelly JP, Tappy L (1997). Energy metabolism in sepsis and injury. Nutrition 13, 45–51.

    Article  Google Scholar 

  • Conjard A, Ferrier B, Martin M, Caillette A, Carrier H, Baverel G (1995). Effects of chronic renal failure on enzymes of energy metabolism in individual human muscle fibers. J Am Soc Nephrol 6, 68–74.

    CAS  PubMed  Google Scholar 

  • Cuppari L, Avesani CM (2004). Energy requirements in patients with chronic kidney disease. J Renal Nutr 14, 121–126.

    Article  Google Scholar 

  • Cuppari L, Carvalho AB, Avesani C, Kamimura MA, Lobão RRS, Draibe SA (2004). Increased resting energy expenditure in hemodialysis patients with severe secondary hiperparathyroidism. J Am Soc Nephrol 15, 2933–2939.

    Article  Google Scholar 

  • Docci D, Bilancioni R, Buscaroli A, Baldrati L, Capponcini C, Mengozzi S et al. (1990). Elevated serum levels of C-reactive protein in hemodialysis patients. Nephron 56, 364–367.

    Article  CAS  Google Scholar 

  • Durnin JVGA, Womersley J (1974). Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged 16 to 72 years. Br J Nutr 32, 77–97.

    Article  CAS  Google Scholar 

  • Falconer JE, Fearon KCH, Plester CE, Ross JA, Carter DC (1994). Cytokines, the acute-phase response, and resting energy expenditure in cachectic patients with pancreatic cancer. Ann Surg 219, 325–331.

    Article  CAS  Google Scholar 

  • Garber AJ (1983). Effect of parathyroid on skeletal muscle protein and aminoacid metabolism in the rat. J Clin Invest 71, 1806–1821.

    Article  CAS  Google Scholar 

  • Garcia-Lorda P, Serrano P, Jiménez-Exposito J, Fraile J, Bullo M, Alonso C et al. (2000). Cytokine-driven inflammatory response is associated with the hypermetabolism of AIDS patients with opportunistic infections. J Parent Enteral Nutr 24, 317–322.

    Article  CAS  Google Scholar 

  • Ikizler TA, Pupim LB, Brouillette JR, Levenhagen DK, Farmer K, Hakim RM et al. (2002). Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Endocrinol Metab 282, 107–116.

    Article  Google Scholar 

  • Ikizler TA, Wingard RL, Sun M, Harvell J, Parker RA, Hakim RM (1996). Increased energy expenditure in hemodialysis patients. J Am Soc Nephrol 7, 2646–2656.

    CAS  PubMed  Google Scholar 

  • Institute of Medicine/Food and Nutrition Board (2002). Dietary Reference Intakes for Energy. National Academy Press:Washington.

  • Kaizu Y, Ohkawa S, Odamaki M, Ikegaya N, Hibi I, Miyaji K et al. (2003). Association between inflammatory mediators and muscle mass in long-term hemodialysis patients. Am J Kidney Dis 42, 295–302.

    Article  CAS  Google Scholar 

  • Kamimura MA, Avesani CM, Cendoroglo M, Canziani MEF, Draibe SA, Cuppari L (2003). Comparison of skinfold thicknesses and bioelectrical impedance analysis with dual-energy X-ray absorptiometry for the assessment of body fat in patients on long-term hemodialysis therapy. Nephrol Dial Transplant 18, 101–105.

    Article  Google Scholar 

  • Kleinbaum DG, Kupper LL, Muller KE, Nizam A (1998). Analysis of covariance and other methods for adjusting continuous data. In: Kleinbaum DG, Kupper LL, Muller KE, Nizam A (eds). Applied regression analyses and other multivariate method. 3rd ed, Duxbury Press: Pacific Grove, 361–385.

    Google Scholar 

  • Kurnik BRC, Weisberg LS, Kurnik PB (1992). Renal and systemic oxygen consumption in patients with normal and abnormal renal fucntion. J Am Soc Nephrol 2, 1617–1626.

    CAS  PubMed  Google Scholar 

  • McIntyre C, Harper I, Macdougall IC, Raine AE, Williams A, Baker LR (1997). Serum C-reactive protein as a marker for infection and inflammation in regular dialysis patients. Clin Nephrol 48, 371–374.

    CAS  PubMed  Google Scholar 

  • Mitch WE, Du J, Bailey JL, Price SR (1999). Mechanisms causing muscle proteolysis in uremia: the influence of insulin and cytokines. Miner Electrolyte Metab 25, 216–219.

    Article  CAS  Google Scholar 

  • Monteon FJ, Laidlaw ST, Shaib JK, Kopple JD (1986). Energy expenditure in patients with chronic renal failure. Kidney Int 30, 741–747.

    Article  CAS  Google Scholar 

  • National Kidney Foundation (2001). DOQI – kidney disease outcome quality initiative, clinical practice guidelines. Am J Kidney Dis 37 (Suppl 1), S27–S33.

  • Om P, Hohenegger M (1980). Energy metabolism in acute uremic rats. Nephron 25, 249–253.

    Article  CAS  Google Scholar 

  • Ortega O, Rodrigues I, Gallar P, Carreno A, Ortiz M, Espejo B et al. (2002). Significance of high C-reactive protein levels in pre-dialysis patients. Nephrol Dial Transplant 17, 1105–1109.

    Article  Google Scholar 

  • O'Sullivan AJ, Lawson JA, Chan M, Kelly JJ (2002). Body composition and energy metabolism in chronic renal insufficiency. Am J Kidney Dis 39, 369–375.

    Article  Google Scholar 

  • Ravussin E, Bogardus C (1989). Relationship of genetics, age, and physical fitness to daily energy expenditure and fuel utilization. Am J Clin Nutr 49, 968–975.

    Article  CAS  Google Scholar 

  • Riley M, Elborn JS, McKane WR, Bell N, Stanford CF, Nicholls DP (1991). Resting energy expenditure in chronic cardiac failure. Clin Sci 80, 633–639.

    Article  CAS  Google Scholar 

  • Roubenoff R, Roubenoff RA, Cannon JG, Kehayias JJ, Zhuang H, Dawson-Hughes B et al. (1994). Rheumatoid cachexia: cytokine-driven hypermetabolism accompanying reduced body cell mass in chronic inflammation. J Clin Invest 93, 2379–2386.

    Article  CAS  Google Scholar 

  • Schneeweiss B, Wolfgang G, Stockenhuber F, Druml W, Ferenci P, Eichinger S et al. (1990). Energy metabolism in acute and chronic renal failure. Am J Clin Nutr 52, 596–601.

    Article  CAS  Google Scholar 

  • Silva P (1987). Renal fuel utilization, energy requirements, and function. Kidney Int 32 (Suppl 22), S9–S14.

    Google Scholar 

  • Siri WE (1961). Body composition from fluid spaces and density: analysis of methods. In: Brozek J, Henschel A (eds). Techniques for Measuring Body Composition. National Research Council: Washington, pp 223–244.

    Google Scholar 

  • Stenvinkel P, Yeun JY (2004). Role of inflammation in malnutrition and atherosclerosis in chronic renal failure.In: Kopple JD, Massry 2nd SG (eds). Lippincott Williams & Wilkins: Philadelphia. pp 199–212.

  • Utaka S, Avesani CM, Draibe S, Kamimura MA, Andreoni S, Cuppari L (2005). Inflammation is associated with increased energy expenditure in chronic kidney disease patients. Am J Clin Nutr 82, 801–805.

    Article  CAS  Google Scholar 

  • Veeneman JM, Kingma HA, Boer TS, Stellaard F, Jong PE, Reijngoud DJ et al. (2004). The metabolic response to ingested protein is normal in long-term hemodialysis patients. Am J Kidney Dis 43, 330–341.

    Article  CAS  Google Scholar 

  • Wang AY, Sea MM, Tang N, Sanderson JE, Li PKT, Woo J (2004). Resting energy expenditure and subsequent mortality risk in peritoneal dialysis patients. J Am Soc Nephrol 15, 3134–3143.

    Article  Google Scholar 

  • Weir JBV (1949). New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol Lond 109, 1–9.

    Article  Google Scholar 

  • Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C (1999). Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 55, 1956–1960.

    Article  Google Scholar 

Download references

Acknowledgements

This study is dedicated to the memory of Nelma Scheyla José dos Santos who believed in this work. This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo (Fapesp) and Oswaldo Ramos Foundation.

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Correspondence to L Cuppari.

Additional information

Guarantors: MA Kamimura and L Cuppari.

Contributors: MAK carried out this study as part of PhD program and was responsible for recruitment of patients, data collection, analysis and interpretation of results, and writing of the manuscript. CMA contributed with the assessment of patients and interpretation of results, and reviewed the manuscript. MEFC and FABC were involved in the study design and data analysis. SAD and LC were the coordinators of the research.

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Kamimura, M., Draibe, S., Avesani, C. et al. Resting energy expenditure and its determinants in hemodialysis patients. Eur J Clin Nutr 61, 362–367 (2007). https://doi.org/10.1038/sj.ejcn.1602516

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