Góes Cassiana Regina de, Sanches Ana Claudia Soncini, Balbi André, Ponce Daniela
Universidade Estadual Paulista, Brazil.
J Bras Nefrol. 2017 Mar;39(1):15-22. doi: 10.5935/0101-2800.20170003.
It is needed for nutrition prescription correct estimate of resting energy expenditure (REE), which is a challenge given the possible daily variation in critically ill patients with acute kidney injury (AKI).
To evaluate the daily variability of REE measured by indirect calorimetry (IC) in patients with AKI and dialysis indication and identify clinical variables associated with REE.
The REE was measured on the time of dialysis indication and the subsequent four days. We also evaluated parameters that can influence the REE. The daily differences were analyzed by generalized linear model for repeated measures. We also used Spearman correlation and multiple linear regression.
There were 301 IC measurements in 114 patients, mean age of 60.65 ± 16.9 years and 68.4% were male. The average REE was 2081 ± 645 kcal, rising on day 5 (2270 ± 556 kcal) compared to the days 2 and 3 (2022 ± 754; 2022 ± 660 kcal, respectively, p = 0,04). When normalized to weight, there was no significant difference in REE (kcal/kg/day) during follow-up. REE was positively correlated with total leukocyte count, C-reactive protein, minute volume (MV), fraction of inspired oxygen (FiO2) urea nitrogen appearance (UNA), weight and height and inversely with age. After multiple regression, MV, FiO2, weight and age are correlated independently with REE.
Patients with AKI have REE stable. The REE was associated independently with FiO2, MV, body weight and age. Thus, ventilatory parameters should be evaluated each day for the necessary dietary changes may be made.
营养处方需要准确估计静息能量消耗（REE），对于急性肾损伤（AKI）的重症患者而言，鉴于其每日能量消耗可能存在变化，这是一项挑战。
评估间接测热法（IC）测量的AKI合并透析指征患者REE的每日变异性，并确定与REE相关的临床变量。
在透析指征确定时及随后四天测量REE。我们还评估了可能影响REE的参数。采用重复测量的广义线性模型分析每日差异。我们还使用了Spearman相关性分析和多元线性回归。
114例患者共进行了301次IC测量，平均年龄60.65±16.9岁，男性占68.4%。平均REE为2081±645千卡，与第2天和第3天（分别为2022±754；2022±660千卡）相比，第5天升高（2270±556千卡，p = 0.04）。按体重标准化后，随访期间REE（千卡/千克/天）无显著差异。REE与白细胞总数、C反应蛋白、分钟通气量（MV）、吸入氧分数（FiO2）、尿素氮出现率（UNA）、体重和身高呈正相关，与年龄呈负相关。多元回归分析后，MV、FiO2、体重和年龄与REE独立相关。
AKI患者的REE稳定。REE与FiO2、MV、体重和年龄独立相关。因此，应每日评估通气参数，以便进行必要的饮食调整。
