估算慢性肾脏病患者静息能量消耗的新方程。
Novel equation for estimating resting energy expenditure in patients with chronic kidney disease.
作者信息
Xu Xiao, Yang Zhikai, Ma Tiantian, Li Ziqian, Chen Yuan, Zheng Yingdong, Dong Jie
机构信息
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.
出版信息
Am J Clin Nutr. 2021 Jun 1;113(6):1647-1656. doi: 10.1093/ajcn/nqaa431.
BACKGROUND
In chronic kidney disease (CKD), determining energy expenditure is the precondition for recommending energy intake in nutrition management.
OBJECTIVES
We aimed to develop and validate a resting energy expenditure (REE) equation for patients with CKD.
METHODS
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.
RESULTS
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.
CONCLUSIONS
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.
背景
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。
目的
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。
方法
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。
结果
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。
结论
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。
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