Resting energy expenditure during hemodialysis

Czech version

Authors: M. Fořtová ¹; S. Dusilová Sulková ^1,2; J. Horáček ³; F. Lopot ¹; T. Zima ⁴; J. Bláha ¹; V. Bednářová ¹; V. Polakovič ¹
Authors‘ workplace: Interní oddělení Strahov 1. lékařské fakulty UK a VFN, Praha, přednosta prim. MUDr. Vladimír Polakovič, MBA ¹; I. interní klinika 3. lékařské fakulty UK a FN Královské Vinohrady, Praha, přednosta prof. MUDr. Jiří Horák, CSc. ²; II. interní klinika Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ³; Ústav klinické biochemie a laboratorní diagnostiky 1. lékařské fakulty UK a VFN, Praha, přednosta prof. MUDr. Tomáš Zima, DrSc., MBA ⁴
Published in: Vnitř Lék 2006; 52(1): 26-33
Category: Original Contributions

Overview

Very few studies have so far reported about resting energy expenditure (REE) in chronic renal failure and there is no information available on REE during hemodialysis (HD). Hypothetically, we can expect an increase in REE during HD procedure (due to the inflammatory response to extracorporeal blood circuit). However, such increase in REE could be modified by thermal balance of the procedure. In our study, REE was measured by indirect calorimetry (Deltatrac Datex) in a group of 13 HD patients (7 males and 6 females, mean age 59.8 ± 13.5 years). In each patient, REE was assessed during two HD sessions: one isothermic and one thermoneutral. All other HD parameters were kept constant. The control group consisted of 14 healthy subjects (4 males and 10 females, mean age 41.3 ± 20.5 years) with normal renal function. There was a significant difference in thermal balance between the two HD settings: –199 kJ/HD in isothermic and –4kJ/HD in thermoneutral HD sessions (p < 0.01). Measured REE values obtained in HD patients before HD session (7 316 ± 919 kJ/day/1.73 m²) did not differ significantly from those of the healthy controls (7 264 ± 1 016 kJ/day/1.73 m²). Similarly, there was no significant difference in calculated EE values (Harris- Benedict equation). In the 10^th minute of the HD session, there was a slight, transitory decrease in REE (mean decrease by 3.2 % during isothermic and by 2.8 % during thermoneutral HD session, ns). In the 70^th minute, REE returned to pre-dialysis values. After a light meal in the 110^th minute REE increased by 8 % during isothermic and by 6.3 % during thermoneutral HD session. At the end of the HD session (i.e. in the 215^th minute) REE again returned to pre-dialysis values. Intra-dialysis changes in REE were similar in both isothermic and thermoneutral HD sessions. The results of our study did not confirm the expected influence of HD procedure on REE in the two different thermal HD settings. We conclude that there is no significant difference between REE in HD patients and healthy controls and that REE values are not significantly influenced by hemodialysis procedure.

Key words:
resting energy expenditure – chronic renal failure – hemodialysis – indirect calorimetry – energy balance

Sources

1. Klener P et al. Vnitřní lékařství. 2. ed. Praha: Galén 2001.

2. Monteon FJ, Laidlaw SA, Shaib JK et al. Energy expenditure in patients with chronic renal failure. Kidney Int 1986; 30: 741-747.

3. Sulková S et al. Hemodialýza. Praha: Maxdorf Jessenius 2000.

4. Kuhlmann U, Schwickardi M, Trebst R et al. Resting metabolic rate in chronic renal failure. J Ren Nutr 2001; 11: 202-206.

5. Avesani CM, Santos NSJ, Draibe SA et al. Resting energy expenditure (REE) of stable chronic renal failure patients with no signs of inflammation. J Am Soc Nephrol 2001; 12: 2364-2370.

6. Avesani CM, Cuppari L, Silva AC et al. Resting energy expenditure in pre-dialysis diabetic patients. Nephrol Dial Transplant 2001; 16: 556-560.

7. Sulková S, Lopot F, Ságová M et al. Klinický význam individualizace teplotní bilance během hemodialýzy. Aktuality v nefrologii 2001; 7: 19-29.

8. Braunwald E, Fauci AS, Kasper DL et al. Harrison´s principles of internal medicine. 15. ed. McGraw-Hill 2001.

9. Lopot F, Nejedlý B, Sulková S. Continuous blood volume monitoring and ultrafiltration kontrol. Hemodial Int 2000; 4: 8-14.

10. Schneeweiss B, Graninger W, Stockenhuber F et al. Energy metabolism in acute and chronic renal failure. Am J Clin Nutr 1990; 52: 596-601.

11. Ikizler TA, Wingard RL, Sun M et al. Increased energy expenditure in hemodialysis patients. J Am Soc Nephrol 1996; 7: 2646-2653.

12. Avesani CM, Draibe SA, Kamimura MA et al. Resting energy expenditure of chronic kidney disease patients: Influence of renal function and subclinical inflammation. J Am Kidney Dis 2004; 44: 1008-1016.

13. Dickerson RN, Gervasio JM, Riley ML et al. Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients. J Parenter Enteral Nutr 2002; 26: 17-21.

14. Tabakian A, Juillard L, Laville M et al. Effects of recombinant growth factors on energy expenditure in maintenance hemodialysis patients. Miner Electrolyte Metab 1998; 24: 273-278.

15. Garibotto G, Barreca A, Sofia A et al. Effects of growth hormone on leptin metabolism and energy expenditure in hemodialysis patients with protein-calorie malnutrition. J Am Soc Nephrol 2000; 11: 2106-2113.

16. de Pascale E, Giordano M, Carone M et al. Impaired glucose oxidation and glucose-induced thermogenesis in renal transplant recipients. Nephrol Dial Transplant 2000; 15: 1658-1662.

17. Neyra R, Chen KY, Sun M et al. Increased resting energy expenditure in patients with end-stage renal disease. J Parenter Enteral Nutr 2003; 27: 36-42.

18. Cuppari L, de Carvalho AB, Avesani CM et al. Increased resting energy expenditure in hemodialysis patients with severe hyperparathyroidism. J Am Soc Nephrol 2004; 15: 2933-2939.

19. Wang AYM, Sea MMM, Tang N et al. Resting energy expenditure and subsequent Mortality risk in peritoneal dialysis patients. J Am Soc Nephrol 2004; 15: 3134-3143.