Neyra Roxanna, Chen Kong Y, Sun Ming, Shyr Yu, Hakim Raymond M, Ikizler T Alp
Arizona Kidney Disease Center, Phoenix, USA.
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):36-42. doi: 10.1177/014860710302700136.
Protein-calorie malnutrition is a significant problem for patients with end-stage renal disease. Increased resting energy expenditure may be an important contributing factor. We postulate that resting energy expen diture in the different stages of renal disease and treatments may be different.
Resting energy expenditure was measured using a whole-room indirect calorimeter (metabolic chamber) along with nutritional parameters and body composition after 12-hour fasting in 15 patients with advanced chronic renal failure patients, 15 patients on chronic hemodialysis, and 10 patients on peritoneal dialysis. Patients on hemodialysis were assessed on a non-dialysis day. A 2-day dietary recall was used to assess energy intake.
Resting energy expenditure, adjusted for fat-free mass, was similar in patients on hemodialysis and peritoneal dialysis but significantly higher than in patients with chronic renal failure (p < .05). Resting energy expenditure in all patients were generally higher (10% to 20%) than predicted values using standard equations derived in normal and obese populations, whereas daily energy intake was less (26% to 34%) than energy expenditure for all groups, adjusted for light daily activity.
End-stage renal disease patients displayed increases in resting energy expenditure over the predicted values derived using normal populations. Resting energy expenditure was significantly higher in patients receiving dialysis, regardless of the modality, than patients with chronic renal failure. Daily energy intake was substantially less than required in all patient groups studied, suggesting that patients with renal failure could develop protein-calorie malnutrition because of increased resting energy expenditure, which is exacerbated by dialysis.
蛋白质 - 热量营养不良是终末期肾病患者面临的一个重大问题。静息能量消耗增加可能是一个重要的促成因素。我们推测肾病不同阶段及治疗方式下的静息能量消耗可能有所不同。
对15例晚期慢性肾衰竭患者、15例接受慢性血液透析的患者和10例接受腹膜透析的患者，在禁食12小时后，使用全室间接热量计（代谢室）测量静息能量消耗，并测量营养参数和身体成分。血液透析患者在非透析日进行评估。采用2天饮食回顾法评估能量摄入。
经去脂体重校正后，血液透析患者和腹膜透析患者的静息能量消耗相似，但显著高于慢性肾衰竭患者（p <.05）。所有患者的静息能量消耗普遍高于使用正常和肥胖人群推导的标准方程预测值（10%至20%），而调整轻度日常活动后，所有组的每日能量摄入量均低于能量消耗（26%至34%）。
终末期肾病患者的静息能量消耗高于使用正常人群推导的预测值。无论采用何种透析方式，接受透析的患者的静息能量消耗均显著高于慢性肾衰竭患者。所有研究患者组的每日能量摄入量均远低于所需量，这表明肾衰竭患者可能因静息能量消耗增加而发生蛋白质 - 热量营养不良，而透析会加剧这种情况。
