Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Division of Pulmonology and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Ren Nutr. 2024 Mar;34(2):115-124. doi: 10.1053/j.jrn.2023.09.006. Epub 2023 Oct 2.
The incidence of acute kidney injury (AKI) is identified more frequently in noncritical compared with intensive care settings. The prognosis of malnourished AKI patients is far worse than those with normal nutritional status. However, a method for estimating the optimal amount of energy required to guide nutritional support among noncritically ill AKI patients is yet to be determined.
We evaluated the performance of weight-based formulas (20-30 kcal/kg/day) with the reference values of energy expenditure (EE) measured by indirect calorimetry (IC) among noncritically ill AKI patients during hospitalization. The statistics for assessing agreement, including total deviation index and accuracy within 10% represent the percentage of estimations falling within the IC value range of ±10%, were tested. Parameters for predicting the EE equation were also developed using a regression analysis model.
A total of 40 noncritically ill AKI patients were recruited. The mean age of participants was 62.5 ± 16.5 years with 50% being male. The average IC-derived EE was 1,124.6 ± 278.9 kcal/day with respiratory quotients 0.8-1.3, indicating good validity of the IC test. Receiving dialysis, protein catabolic rate, and age was not significantly associated with measured EE. Nearly all weight-based formulas overestimated measured EE. The magnitude of total deviation index values was broad with the proportion of patients achieving an accuracy of 10% being as low as 20%. The proposed equation to predict EE derived from this study was EE (kcal/day) = 618.27 + (8.98 x weight in kg) + 137.0 if diabetes - 199.7 if female (r = 0.68, P < .001). In the validation study with an independent group of noncritically ill AKI patients, predicted EE using the newly derived equation was also significantly correlated with measured EE by IC (r = 0.69, P = .004).
Estimation of EE by weight-based formulas usually overestimated measured EE among noncritically ill AKI patients. In the absence of IC, the proposed predictive equation, specifically for noncritically ill AKI patients might be useful, in addition to weight-based formulas, for guiding caloric dosing in clinical practice.
与重症监护环境相比，非重症环境中更频繁地发现急性肾损伤（AKI）的发病率。营养不良的 AKI 患者的预后远差于营养状况正常的患者。然而，确定指导非重症 AKI 患者营养支持所需的最佳能量量的方法尚未确定。
我们评估了体重公式（20-30 kcal/kg/天）的性能，该公式基于间接热量测定法（IC）测量的能量消耗（EE）的参考值，用于评估非重症 AKI 患者住院期间的能量消耗。评估一致性的统计数据，包括总偏差指数和准确性在 10%以内，表示估计值落在 IC 值范围±10%以内的百分比，也进行了测试。还使用回归分析模型开发了预测 EE 方程的参数。
共纳入 40 例非重症 AKI 患者。参与者的平均年龄为 62.5±16.5 岁，其中 50%为男性。平均 IC 衍生 EE 为 1124.6±278.9 kcal/天，呼吸商为 0.8-1.3，表明 IC 测试具有良好的有效性。接受透析、蛋白质分解率和年龄与测量的 EE 无显著相关性。几乎所有的体重公式都高估了测量的 EE。总偏差指数值的幅度较宽，达到 10%准确性的患者比例低至 20%。从这项研究中得出的预测 EE 的建议方程为 EE（kcal/天）= 618.27 +（体重（kg）x 8.98）+ 137.0 如果是糖尿病 - 199.7 如果是女性（r=0.68，P<.001）。在使用非重症 AKI 患者的独立组进行的验证研究中，使用新推导的方程预测的 EE 与通过 IC 测量的 EE 也显著相关（r=0.69，P=0.004）。
在非重症 AKI 患者中，基于体重的公式估计 EE 通常会高估测量的 EE。在没有 IC 的情况下，除了体重公式之外，针对非重症 AKI 患者的新推导的预测方程可能有助于指导临床实践中的热量给药。
