Xu Xiao, Yang Zhikai, Ma Tiantian, Li Ziqian, Chen Yuan, Zheng Yingdong, Dong Jie
Renal Division, Department of Medicine, Peking University First Hospital; Institute of Nephrology, Peking University; Key Laboratory of Renal Disease, Ministry of Health; Key Laboratory of Renal Disease, Ministry of Education; Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.
Clinical Nutrition Department, Peking University First Hospital, Beijing, China.
Am J Clin Nutr. 2021 Jun 1;113(6):1647-1656. doi: 10.1093/ajcn/nqaa431.
In chronic kidney disease (CKD), determining energy expenditure is the precondition for recommending energy intake in nutrition management.
We aimed to develop and validate a resting energy expenditure (REE) equation for patients with CKD.
This cross-sectional study enrolled 300 patients with CKD (stages 3-5) according to inclusion and exclusion criteria. Stepwise linear regression analysis was used to derive a new REE equation (eREE-CKD) according to actual REE (aREE) measured using indirect calorimetry in the development dataset. The eREE-CKD value was then validated with aREE in the validation dataset and compared with values from existing equations obtained in general populations, namely, the Harris-Benedict, Mifflin, WHO, and Schofield equations in terms of bias, precision, and accuracy.
The eREE-CKD equation: eREE-CKD (kcal) = (1 if male; 0 if female) × 106.0 - [1 if diabetes mellitus (DM); 0 if non-DM] × 51.6 - 4.7 × age (y) + 13.1 × weight (kg) + 645.5 (R2 = 0.779).The bias, precision, and accuracy (percentage of estimates that differed >20% from the measured REE) of the eREE-CKD equation were -0.4 (IQR: -29.8, 23.8) kcal, 98.4 (IQR: 79.5, 116.6) kcal, and 5.4%, respectively with indirect calorimetry as the reference method. Both bias and precision of the eREE-CKD were significantly better than the Harris-Benedict, WHO, and Schofield equations (P < 0.001) and similar to the Mifflin equation (P = 0.125 for bias and 0.268 for precision). Accuracy of the eREE-CKD was significantly better than the Harris-Benedict, WHO, Mifflin, and Schofield equations (P < 0.001). Bias, precision, and accuracy of the eREE-CKD equation were consistent when applied to subgroups categorized according to high-sensitivity C-reactive protein concentrations and CKD stages, respectively.
The eREE-CKD equation using age, sex, weight, and DM data could serve as a reliable tool for estimating REE in patients with CKD. This trial was registered at clinicaltrials.gov as NCT03377413.
在慢性肾脏病（CKD）中，确定能量消耗是营养管理中推荐能量摄入的前提条件。
我们旨在开发并验证一种适用于CKD患者的静息能量消耗（REE）方程。
本横断面研究根据纳入和排除标准招募了300例CKD患者（3-5期）。在开发数据集中，使用逐步线性回归分析，根据间接测热法测得的实际REE（aREE）推导出一个新的REE方程（eREE-CKD）。然后，在验证数据集中用aREE对eREE-CKD值进行验证，并在偏差、精密度和准确性方面，将其与从一般人群中获得的现有方程（即Harris-Benedict方程、Mifflin方程、WHO方程和Schofield方程）的值进行比较。
eREE-CKD方程：eREE-CKD（千卡）=（男性为1；女性为0）×106.0 - [患有糖尿病（DM）为1；非DM为0]×51.6 - 4.7×年龄（岁）+ 13.1×体重（千克）+ 645.5（R2 = 0.779）。以间接测热法作为参考方法时，eREE-CKD方程的偏差、精密度和准确性（与测得的REE相差>20%的估计值百分比）分别为-0.4（四分位间距：-29.8，23.8）千卡、98.4（四分位间距：79.5，116.6）千卡和5.4%。eREE-CKD的偏差和精密度均显著优于Harris-Benedict方程、WHO方程和Schofield方程（P < 0.001），与Mifflin方程相似（偏差P = 0.125，精密度P = 0.268）。eREE-CKD的准确性显著优于Harris-Benedict方程、WHO方程、Mifflin方程和Schofield方程（P < 0.001）。当分别应用于根据高敏C反应蛋白浓度和CKD分期分类的亚组时，eREE-CKD方程的偏差、精密度和准确性是一致的。
使用年龄、性别、体重和DM数据的eREE-CKD方程可作为估算CKD患者REE的可靠工具。本试验在clinicaltrials.gov上注册，注册号为NCT03377413。
