Hung Rachel, Sridharan Sivakumar, Farrington Ken, Davenport Andrew
UCL Centre for Nephrology, Royal Free Hospital, University College London Medical School, London - UK.
Renal Unit, Lister Hospital, Stevenage - UK.
Int J Artif Organs. 2017 Apr 21;40(3):96-101. doi: 10.5301/ijao.5000575. Epub 2017 Mar 27.
Waste products of metabolism accumulate in patients with chronic kidney disease, and require clearance by haemodialysis (HD). We wished to determine whether there was an association between resting energy expenditure (REE) and total energy expenditure (TEE) in HD patients and body composition.
SUBJECTS/METHODS: We determined REE by recently validated equations (CKD equation) and compared REE with that estimated by standard equations for REE, and TEE calculated from patient reported physical activity, in HD patients with corresponding body composition measured by dual energy X-ray absorptiometry (DEXA) scanning.
We studied 107 patients, 69 male (64.5%), mean age 62.7 ± 15.1 years. The CKD equation REE was 72.5 ± 13.3 watts (W) and TEE 83.2 ± 9.7 W. There was a strong association between REE with body surface area (BSA) (r2 = 0.80), total soft lean and fat lean tissue mass (r2 = 0.69), body mass index (BMI) (r2 = 0.34), all p<0.001. REE estimated using the modified Harris Benedict, Mifflin St. Jeor, Katch McArdle, Bernstein and Robertson equations underestimated REE compared to the CKD equation. TEE was more strongly associated with BSA (r2 = 0.51), appendicular muscle mass (r2 = 0.42), than BMI (r2 = 0.15) all p<0.001.TEE was greater for those employed (104.9 ± 10.7 vs. 83.1 ± 12.3 W, p<0.001), and with no co-morbidity (88.7 ± 14.8 vs. 82.7 ± 12.3 W, p<0.05).
Standard equations underestimate REE in HD patients compared to the CKD equation. TEE was greater in those with more skeletal muscle mass, in those who were employed and in those with the least co-morbidity. More metabolically active patients may well require greater dialytic clearances.
慢性肾病患者体内会积累代谢废物，需要通过血液透析（HD）清除。我们希望确定血液透析患者的静息能量消耗（REE）和总能量消耗（TEE）与身体成分之间是否存在关联。
受试者/方法：我们通过最近验证的公式（CKD公式）测定REE，并将其与通过REE标准公式估算的值以及根据患者报告的身体活动计算出的TEE进行比较，这些血液透析患者的身体成分通过双能X线吸收法（DEXA）扫描测量。
我们研究了107名患者，其中69名男性（64.5%），平均年龄62.7±15.1岁。CKD公式计算的REE为72.5±13.3瓦（W），TEE为83.2±9.7 W。REE与体表面积（BSA）（r2 = 0.80）、总软瘦组织和脂肪瘦组织质量（r2 = 0.69）、体重指数（BMI）（r2 = 0.34）之间存在很强的关联，所有p<0.001。与CKD公式相比，使用改良的哈里斯-本尼迪克特公式、米夫林-圣乔尔公式、卡奇-麦卡德尔公式、伯恩斯坦公式和罗伯逊公式估算的REE均低估了REE。TEE与BSA（r2 = 0.51）、附属肌肉质量（r2 = 0.42）的相关性比与BMI（r2 = 0.15）更强，所有p<0.001。就业者的TEE更高（104.9±10.7 vs. 83.1±12.3 W，p<0.001），且无合并症者的TEE更高（88.7±14.8 vs. 82.7±12.3 W，p<0.05）。
与CKD公式相比，标准公式低估了血液透析患者的REE。骨骼肌质量更多、就业以及合并症最少的患者TEE更高。代谢活性更高的患者可能需要更大的透析清除率。
