de Oliveira Mariana Cassani, Bufarah Marina Nogueira Berbel, Ponce Daniela, Balbi André Luís
Botucatu School of Medicine University Hospital, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Botucatu18618687, Botucatu, Brazil.
Botucatu School of Medicine University Hospital, Av. Prof. Mário Rubens Guimarães Montenegro, s/n, UNESP - Botucatu18618687, Botucatu, Brazil.
Clin Nutr ESPEN. 2018 Dec;28:136-140. doi: 10.1016/j.clnesp.2018.08.014. Epub 2018 Sep 23.
BACKGROUND/AIMS: Protein-energy wasting (PEW) is common in the end-stage of chronic kidney disease (CKD) and can be caused by factors related to poor dietary intake and changes in energy expenditure. Indirect calorimetry (IC) is the gold standard method to measure resting energy expenditure (REE), however, it is not much available and it is common to use predictive formulas of REE in clinical practice. This study compared the values of REE measured by IC to those estimated by Harris & Benedict formula, the most one used in clinical practice in Brazil.
Patients with stage 5 CKD (an estimated glomerular filtration rate <15 mL/min/1.73 m), >18 years old were included and submitted to the IC test and Harris & Benedict's predictive formula. The assessments were performed at three moments: pre-dialysis indications (P1), at the beginning of dialysis indication (P2) and 30 days after the start of dialysis therapy (P3). Tuckey's test was used to compare energy expenditure variable by groups, and the Bland & Altman analysis was used to compare the agreement between the methods. A significance level of p < 0.05 and agreement limits of up to 200 Kcal were used.
Thirty-five patients with mean age of 61.2 ± 10.9 years were included, 60% female, 17% afrodescendants and 60% with diabetes mellitus. There were no significant differences in REE between the three moments (P1: 1289.8 ± 382.7 kcal, P2: 1218.2 ± 362.8 kcal, P3: 1269.5 ± 335.1 kcal, p = 0.874). Harris & Benedict formula did not show IC agreement for the REE measurement because it presented high limits of agreement or because of the low precision of the estimated measure.
This study showed that there was no significant alteration of REE by IC and that REE values estimated by Harris & Benedict formula did not agree with the values measured by IC in this population. The role of Harris & Benedict formula should be re-evaluated in stage 5 CKD patients.
背景/目的：蛋白质能量消耗（PEW）在慢性肾脏病（CKD）终末期很常见，可能由饮食摄入不佳和能量消耗变化等因素引起。间接测热法（IC）是测量静息能量消耗（REE）的金标准方法，然而，该方法应用并不广泛，临床实践中常用REE预测公式。本研究比较了通过IC测量的REE值与巴西临床实践中最常用的Harris & Benedict公式估算的REE值。
纳入年龄大于18岁的5期CKD（估计肾小球滤过率<15 mL/min/1.73 m²）患者，进行IC测试和Harris & Benedict预测公式评估。评估在三个时间点进行：透析前指征（P1）、透析指征开始时（P2）和透析治疗开始后30天（P3）。采用Tuckey检验比较各组能量消耗变量，采用Bland & Altman分析比较两种方法之间的一致性。显著性水平设定为p < 0.05，一致性界限设定为±200千卡。
纳入35例患者，平均年龄61.2 ± 10.9岁，60%为女性，17%为非洲裔，60%患有糖尿病。三个时间点的REE无显著差异（P1：1289.8 ± 382.7千卡，P2：1218.2 ± 362.8千卡，P3：1269.5 ± 335.1千卡，p = 0.874）。Harris & Benedict公式在测量REE时与IC结果不一致，原因是一致性界限较高或估算测量精度较低。
本研究表明，IC测量的REE无显著变化，且Harris & Benedict公式估算的REE值与该人群IC测量值不一致。对于5期CKD患者，应重新评估Harris & Benedict公式的作用。
