CHU Clermont-Ferrand, Nephrology, Dialysis and Transplantation Department, Gabriel Montpied Hospital, Clermont-Ferrand, France; Clermont Auvergne University, INRAE, Human Nutrition Unit, CRNH Auvergne, Clermont-Ferrand, France.
Clermont Auvergne University, INRAE, Human Nutrition Unit, CRNH Auvergne, Clermont-Ferrand, France.
Clin Nutr. 2021 May;40(5):3454-3461. doi: 10.1016/j.clnu.2020.11.028. Epub 2020 Nov 28.
Automated peritoneal dialysis (APD) treatment for end-stage kidney disease affords patients a degree of autonomy in everyday life. Clinical investigations of their energy expenditure (EE) are usually based on resting EE, which could mask day and night variations in EE. The aim of this study, therefore, was to compare the components of EE in APD patients and healthy control (C) subjects.
Patients treated with APD for more than 3 months were compared with C volunteers matched for age and lean body mass (LBM). Biochemical analyses were performed and body composition was determined by DEXA to adjust EE to LBM. Total EE, its different components and respiratory quotients (RQ) were measured by a gas exchange method in calorimetric chambers. Spontaneous total and activity-related EE (AEE) were also measured in free-living conditions over 4 days by a calibrated accelerometer and a heart rate monitor.
APD (n = 7) and C (n = 7) patients did not differ in age and body composition. REE did not differ between the two groups. However, prandial increase in EE adjusted for dietary energy intake was higher in APD patients (+57.5 ± 12.71 kcal/h) than in C subjects (+33.8 ± 10.5 kcal/h, p = 0.003) and nocturnal decrease in EE tended to be lower in APD patients undergoing dialysis sessions (- 4.53 ± 8.37 kcal/h) than in subjects (- 11.8 ± 7.69 kcal/h, p = 0.059). Resting RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p = 0.032) and nocturnal RQ (0.91 ± 0.09 vs 0.81 ± 0.04, p = 0.032) were significantly higher in APD patients, indicating a preferential use of glucose substrate potentially absorbed across the peritoneum. AEE was lower in APD patients (595.9 ± 383.2 kcal/d) than in C subjects (1205.2 ± 370.5 kcal/d, p = 0.011). In contrast, energy intakes were not significantly different (1986 ± 465 vs 2083 ± 377 kcal/d, p = 0.677).
Although the two groups had identical resting EE, APD patients had a higher prandial increase in EE, a lower activity-related EE and higher resting and nocturnal RQ than healthy subjects.
自动化腹膜透析（APD）治疗终末期肾病可使患者在日常生活中获得一定程度的自主性。对其能量消耗（EE）的临床研究通常基于静息 EE，这可能掩盖了 EE 的昼夜变化。因此，本研究旨在比较 APD 患者和健康对照（C）受试者的 EE 成分。
将接受 APD 治疗超过 3 个月的患者与年龄和去脂体重（LBM）匹配的 C 志愿者进行比较。通过 DEXA 进行生化分析和身体成分测定，以调整 EE 至 LBM。在代谢室中通过气体交换法测量总 EE、其不同成分和呼吸商（RQ）。通过经过校准的加速度计和心率监测器在 4 天的自由生活条件下还测量了自发的总 EE 和与活动相关的 EE（AEE）。
APD（n=7）和 C（n=7）患者在年龄和身体组成方面没有差异。两组之间 REE 没有差异。然而，APD 患者的膳食能量摄入校正后的餐后 EE 增加（+57.5±12.71 千卡/小时）高于 C 组（+33.8±10.5 千卡/小时，p=0.003），APD 患者在透析期间夜间 EE 下降趋势较低（-4.53±8.37 千卡/小时）低于 C 组（-11.8±7.69 千卡/小时，p=0.059）。APD 患者的静息 RQ（0.91±0.09 比 0.81±0.04，p=0.032）和夜间 RQ（0.91±0.09 比 0.81±0.04，p=0.032）显著更高，表明葡萄糖底物的优先利用可能是通过腹膜吸收的。APD 患者的 AEE 低于 C 组（595.9±383.2 千卡/天）（1205.2±370.5 千卡/天，p=0.011）。相反，能量摄入没有显著差异（1986±465 与 2083±377 千卡/天，p=0.677）。
尽管两组的静息 EE 相同，但 APD 患者的餐后 EE 增加更高，与活动相关的 EE 更低，静息和夜间 RQ 更高，而健康受试者则更低。
