Energy requirements in patients with chronic kidney disease.

Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil.
Journal of Renal Nutrition (Impact Factor: 1.75). 08/2004; 14(3):121-6. DOI:10.1053/j.jrn.2004.04.001
Source: PubMed

ABSTRACT Knowledge concerning energy requirements of patients with chronic kidney disease (CKD) is important to providing a sufficient amount of energy to maintain adequate nutritional status for these patients. Data regarding energy expenditures of CKD patients are still scarce, and the results obtained are conflicting, with studies showing energy expenditures to be similar, higher, or lower than those of healthy individuals. More recently, studies focusing the role of the comorbidities and of the dialysis procedure on energy expenditure have been carried out, opening a new field of discussion that may help to clarify the profile of the energy expenditure of CKD patients. Another point of interest is related to the evaluation of energy intake. It has been shown that energy intake of CKD patients is lower than the 30 to 35 kcal/kg/day usually recommended. Although anorexia and consequently reduction of food intake is often present in these patients, a degree of underreporting in energy intake cannot be excluded. This review provides an overview of the studies that evaluated energy expenditures as well as those that studied the energy intakes and energy requirements of patients with CKD.

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    ABSTRACT: • Chronic kidney disease (CKD) often coexists with cardiovascular disease and diabetes and requires medical nutrition therapy for optimal outcomes. • Effective nutritional management should be correlated to the stage of CKD as dietary restriction will vary according to stage. • Prevention of malnutrition is an important goal of medical nutrition therapy. • Management of blood pressure and diabetes will have the greatest impact on delaying the progression of chronic kidney disease. • Diabetes is the leading cause of end-stage renal disease (ESRD). • Nutritional requirements in acute renal failure encompass both the catabolic state and the needs of the patient in renal failure. Key WordsChronic kidney disease-acute renal failure-nutritional management-medical nutrition therapy-hemodialysis-peritoneal dialysis-urinary tract infections
    07/2010: pages 339-350;
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    ABSTRACT: Energy intake, resting energy expenditure, and energy expended for physical activity (EEPA) are components of energy balance that may be disrupted by a number of disorders and clinical conditions commonly present in advanced chronic kidney disease (CKD) and end-stage renal disease (ESRD). Energy intake of patients with CKD has been consistently lower than the recommended intake in multiple reports. On the other hand, while reduced energy intake due to anorexia may be applicable for ESRD patients with overt protein-energy wasting, it is potentially unrealistic for overweight or obese subjects who are able to maintain their body weight. Studies on resting energy expenditure have provided mixed results, most likely as a consequence of differences in the population characteristics, clinical conditions, and stage of the disease. Finally, although there is lack of specific studies on EEPA, there is evidence that ESRD patients, particularly those undergoing hemodialysis are in general less active than sedentary healthy individuals. These observations may raise questions regarding the accuracy of dietary reports and the uncertainties related to the energy requirements, optimal dietary energy intake, and recommendations for physical activity in these patients.
    Seminars in Dialysis 01/2010; 23(4):373-7. · 2.25 Impact Factor
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    ABSTRACT: The determination of resting energy expenditure (REE) is the primary step for estimating the energy requirement of an individual. Although numerous equations have been formulated for predicting metabolic rates, there is a lack of studies addressing the reliability of those equations in chronic kidney disease (CKD). Thus, the aim of this study was to evaluate whether the main equations developed for estimating REE can be reliably applied for CKD patients. A total of 281 CKD patients (124 non-dialysis, 99 haemodialysis and 58 peritoneal dialysis) and 81 healthy control individuals were recruited. Indirect calorimetry and blood sample collection were performed after a 12-h fasting. Two most traditionally used equations for estimating REE were chosen for comparison with the REE measured by indirect calorimetry: (i) the equation proposed by Harris and Benedict, and (ii) the equation proposed by Schofield that is currently recommended by the FAO/WHO/UNU. Schofield's equation exhibited higher REE [1492±220 kcal/day (mean±SD)] in relation to Harris and Benedict's equation (1431±214 kcal/day; P<0.001), and both prediction equations showed higher REE in comparison with the reference indirect calorimetry (1352±252 kcal/day; P<0.001). In patients with diabetes, inflammation or severe hyperparathyroidism, the REE estimated by the Harris and Benedict equation was equivalent to that measured by indirect calorimetry. The intraclass correlation of the REE measured by indirect calorimetry with the Schofield's equation was r=0.48 (P<0.001) and with the Harris and Benedict's equation was r=0.58 (P<0.001). According to the Bland and Altman analysis, there was a large limit of agreement between both prediction equations and the reference method. Acceptable prediction of REE (90-110% adequacy) was found in 47% of the patients by using the Harris and Benedict's equation and in only 37% by using the Schofield's equation. The most traditionally used prediction equations overestimated the REE of CKD patients, and the errors were minimized in the presence of comorbidities. There is a need to develop population-specific equations in order to adequately estimate the energy requirement of these patients.
    Nephrology Dialysis Transplantation 02/2011; 26(2):544-50. · 3.37 Impact Factor


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Jul 4, 2013