Rodrigues Carolina Q D, Santos Jacqueline A P, Quinto Beata M R, Marrocos Mauro S M, Teixeira Andrei A, Rodrigues Cássio J O, Batista Marcelo C
Nephrology Division, Department of Medicine, Universidade Federal de São Paulo, Brazil.
Nephrology Division, Department of Medicine, Universidade Federal de São Paulo, Brazil.
Clin Nutr ESPEN. 2016 Oct;15:107-113. doi: 10.1016/j.clnesp.2016.07.001. Epub 2016 Aug 18.
BACKGROUND & AIMS: Resting energy expenditure (REE) changes in patients with chronic kidney disease (CKD) may contribute to mortality increase. The obesity and inflammation is associated with high REE and when not compensated by adequate intake, may determine an unfavorable clinical outcome in this population. We aimed to evaluate the influence of metabolic syndrome (MetS) on REE in CKD patients.
One hundred eighty-three patients were stratified according to glomerular filtration rate (GFR) and divided in groups: without CKD (GFR > 60 ml/min/1.73 m) and CKD (GFR < 60 ml/min/1.73 m) and according to the presence or absence of MetS. REE was measured by indirect calorimetry; body composition was assessed by bioelectrical impedance analysis and blood and urine were collected for biochemical tests.
REE was lower in the group with CKD compared with those without CKD (1293 ± 364 vs 1430 ± 370 kcal/d, P = 0.01). The group with CKD without MetS showed decrease in REE compared to the groups without CKD, regardless the presence of Mets, and those with CKD and MetS (1173 ± 315 vs 1392 ± 324 vs 1460 ± 410 vs 1424 ± 376 kcal/d, P < 0.05, respectively). Multivariate analysis showed an independent association of CKD in determining REE when adjusted for lean body mass. The inclusion of MetS as an independent variable in the same analysis model neutralized the impact of CKD on the REE (P = 0.19). Patients without MetS, REE correlated with estimated GFR and the protein equivalent (r = 0.33, P < 0.01, r = 0.21, P = 0.04, respectively), whereas in MetS patients, these correlations were not observed.
The presence of CKD is independently associated with reduced REE. The observed decrease in REE is reversed in patients with MetS independent of renal function.
慢性肾脏病（CKD）患者静息能量消耗（REE）的变化可能导致死亡率增加。肥胖和炎症与高REE相关，若未通过充足的摄入量得到补偿，可能会在该人群中导致不良的临床结局。我们旨在评估代谢综合征（MetS）对CKD患者REE的影响。
根据肾小球滤过率（GFR）对183例患者进行分层，并分为以下几组：无CKD（GFR > 60 ml/min/1.73 m²）和CKD（GFR < 60 ml/min/1.73 m²），同时根据是否存在MetS进行分组。通过间接测热法测量REE；采用生物电阻抗分析评估身体成分，并采集血液和尿液进行生化检测。
与无CKD的组相比，CKD组的REE较低（1293 ± 364 vs 1430 ± 370 kcal/d，P = 0.01）。与无CKD的组相比，无MetS的CKD组的REE降低，无论是否存在MetS，以及与有CKD和MetS的组相比（1173 ± 315 vs 1392 ± 324 vs 1460 ± 410 vs 1424 ± 376 kcal/d，P分别< 0.05）。多因素分析显示，在调整瘦体重后，CKD与REE的确定存在独立关联。在同一分析模型中将MetS作为自变量纳入后，抵消了CKD对REE的影响（P = 0.19）。在无MetS的患者中，REE与估计的GFR和蛋白质当量相关（r分别为0.33，P < 0.01；r为0.21，P = 0.04），而在有MetS的患者中，未观察到这些相关性。
CKD的存在与REE降低独立相关。在有MetS的患者中，无论肾功能如何，观察到的REE降低均会逆转。
