Anderson Caroline E, Gilbert Rodney D, Elia Marinos
Department of Nutrition and Dietetics, NIHR Southampton Biomedical Research Centre-Nutrition, Southampton Children's Hospital, University of Southampton-University Hospital Southampton NHS Foundation Trust, E level Tremona Road, Southampton, SO16 6YD, UK.
Southampton Children's Hospital, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
Pediatr Nephrol. 2015 Nov;30(11):1995-2001. doi: 10.1007/s00467-015-3095-5. Epub 2015 May 17.
Meeting energy requirements of children with chronic kidney disease (CKD) is paramount to optimising growth and clinical outcome, but little information on this subject has been published. In this study, we examined basal metabolic rate (BMR; a component of energy expenditure) with the aim to determine whether it is related to kidney function independently of weight, height and lean body mass (LBM).
Twenty children with CKD and 20 healthy age- and gender-matched control children were studied on one occasion. BMR was measured by indirect open circuit calorimetry and predicted by the Schofield equation. Estimated glomerular filtration rate (eGFR) was related to BMR and adjusted for weight, height, age and LBM measured by skinfold thickness.
The adjusted BMR of children with CKD did not differ significantly from that of healthy subjects (1296 ± 318 vs.1325 ± 178 kcal/day; p = 0.720). Percentage of predicted BMR also did not differ between the two groups (102 ± 12% vs. 99 ± 14%; p = 0.570). Within the CKD group, eGFR (mean 33.7 ± 20.5 mL/min/m(2)) was significantly related to BMR (β 0.3, r = 0.517, p = 0.019) independently of nutritional status and LBM.
It seems reasonable to use estimated average requirement as the basis of energy prescriptions for children with CKD (mean CKD stage 3 disease). However, those who were sicker had significantly lower metabolic rates.
满足慢性肾脏病（CKD）患儿的能量需求对于优化生长发育和临床结局至关重要，但关于这一主题的信息鲜有发表。在本研究中，我们检测了基础代谢率（BMR；能量消耗的一个组成部分），旨在确定其是否独立于体重、身高和瘦体重（LBM）与肾功能相关。
对20名CKD患儿和20名年龄及性别匹配的健康对照儿童进行了一次研究。通过间接开路量热法测量BMR，并使用Schofield方程进行预测。估计肾小球滤过率（eGFR）与BMR相关，并针对通过皮褶厚度测量的体重、身高、年龄和LBM进行校正。
CKD患儿校正后的BMR与健康受试者相比无显著差异（1296±318 vs.1325±178千卡/天；p = 0.720）。两组间预测BMR的百分比也无差异（102±12% vs. 99±14%；p = 0.570）。在CKD组内，eGFR（平均33.7±20.5毫升/分钟/1.73平方米）与BMR显著相关（β 0.3，r = 0.517，p = 0.019），独立于营养状况和LBM。
以估计平均需求量作为CKD患儿（平均CKD 3期疾病）能量处方的基础似乎是合理的。然而，病情较重的患儿代谢率明显较低。
