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: 1.87). 08/2004; 14(3):121-6. DOI: 10.1053/j.jrn.2004.04.001
Source: PubMed


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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    • "High PTH levels have been demonstrated to be associated with reduced fat-free mass and increased REE in chronic HD patients (Cuppari et al., 2004). In this recent study, patients "
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    ABSTRACT: 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. Cross-sectional study. Dialysis Unit of the Nephrology Division, Federal University of São Paulo, Brazil. 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. 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 (R (2)=0.64). 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.
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    ABSTRACT: Objectives: Inadequate nutrient intake seems to be one of the most important cause of malnutrition in hemodialysis patients. The purpose of this study was to analyse their nutrient intake and eating habits, comparing food groups' intake with standar Mediterranean diet values (Healthy Diet Guide 2004, Nutrition Community Spanish Society). Material and methods: There were 28 stable hemodialysis (HD) patients, 15 males and 13 females, mean age 62,9 ± 16 years. Dietary evaluation was based on 7-day dietary recalls conduced by a single observer. We compare nu-trients intake with recommended hemodialysis intake and we contrast food groups consumption with the theoretical ideal based on Mediterranean diet. Results: The protein intake was 1,33 ± 0,2 g/kg/day and the energy intake 29,5 ± 2,1 kcal/kg/day. Carbohydrates accounted 43,1% of energy intake, proteins 19% and lipids 37,9% (55,5% monounsaturated fatty acids, 16,4% polyunsaturated fatty acids and 28,1% saturated fatty acids). Complex carbohydrates (potatoes, cereals, vegetables, fruits) and olive oil consumption was lower than that recommended to the Spanish he-althy population and to the chronic hemodialysis patients. The animal protein inta-ke (meat, fish, eggs) was correct, although excessive in red and processed meats. Results: Potatoes and cereals recommended frequency (RF) 4-6 portions/day, HD patients frequency (HDF) 4,1 portions/day; vegetables RF > 2 portions/day, HDF 1,2; fruits RF > 3 portions/day, HDF 1,3; olive oil RF 3-6 portions/day, HDF 1,5; Fish RF 3-4 portions/week, HDF 4,2; White meat RF 3-4 portions/week, HDF 1,5; Poultry RF 3-4 portions/week, HDF 2,3; Eggs RF 3-4 portions/week, HDF 3,6; Pul-ses RF 3-4 portions/week, HDF 1,7; Nuts RF 3-7 portions/week, HDF 0; Red meat RF occasionally, HDF 4,8 portions/week; Processed meats RF occasionally, HDF 4,6 portions/week; Sweets, snacks, soft drinks RF occasionally, HDF 1,7 portions/week; Butter, margarine, processed bakery products, biscuits RF occasionally , HDF 0,5 portions/week. Conclusions: Nutritional abnormalities are frequently found even in apparently stable patients on chronic hemodialysis. Caloric rather than protein un-dernutrition is the major abnormality. Inadequate caloric intake (< 35 kcal/kg/day) can lead to a negative nitrogen balance. Their eating habits are healthy and natu-ral, but there is a deficit in slowly absorbed carbohydrates and olive oil intake (with caloric intake reduction), and an excessive consumption of red and processed meats (with saturated fats increase). The individual correction of these dietary patterns could reduce the saturated fats and increase the energy intake, obtaining a balan-ced diet integrated into our geographic region and culture.
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    ABSTRACT: There is a high prevalence of protein-energy malnutrition (PEM) in chronic dialysis patients. Causes of PEM include the catabolic effects of hemodialysis treatments, acidemia associated with end-stage renal disease, common comorbid conditions, and uremia-induced anorexia. Morbidity and mortality increase with PEM. Before considering parenteral nutrition (PN) as a nutrition intervention in a maintenance dialysis patient, all other efforts to promote optimal nutrition need to be exhausted. The first step is careful evaluation of protein-energy status, followed by intensive nutrition counseling. If necessary, this is followed by oral nutrition supplementation, appetite stimulation, enteral tube feedings, and finally PN. Short-term parenteral nutrition (PN) became a crucial component of the management of a 38-year-old hemodialysis (HD) patient who endured serious complications after kidney transplant rejection. A profound and prolonged malnourished state followed her treatment for necrotizing pancreatitis. She had developed persistent hypercalcemia believed secondary to tertiary hyperparathyroidism (HPT) and immobilization. Later, she developed hungry bone syndrome (HBS) after parathyroidectomy (PTX). She also developed refeeding syndrome after initiation of PN. The patient's persistent, poorly understood hypercalcemia did not resolve even after PTX and removal of all other sources of vitamin D and calcium from her feedings, medications, and dialysis bath. The close communication of the inpatient and outpatient dialysis multidisciplinary teams became a key component to the successful outcome in this complex patient.
    No preview · Article · Nov 2005 · Nutrition in Clinical Practice
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