Determinants of Resting Energy Expenditure in Hemodialysis Patients, and Comparison With Healthy Subjects
Objective
This study evaluated the factors that affect the resting energy expenditure (REE) and nutritional status of hemodialysis patients, and to assess any differences with healthy subjects.
Design
This was an observational case-control study.
Setting
This study took place at the Hemodialysis Units of the Laikon General Hospital and 401 General Military Hospital (Athens, Greece).
Patients
Twenty-five patients undergoing hemodialysis and 23 controls were recruited. Controls were healthy volunteers with no history of diseases or medication use. Patients with active infectious or inflammatory disease were excluded.
Intervention
We measured REE using indirect calorimetry. Body composition as measured by Bioelectrical Impedance Analysis (BIA), anthropometry, and biochemical parameters were assessed in both groups.
Main Outcome Measure
Adjusted or unadjusted for muscle mass, REE was compared between the two groups. Multiple linear regression analysis was used to study independent determinants of REE.
Results
Patients had no clinical signs of malnutrition. Resting energy expenditure was not different between the two groups, but REE adjusted for muscle mass was significanlty higher in hemodialysis patients. There were no differences in body composition, with the exception of muscle mass. Patients had lower muscle mass than controls, as determined by duration of disease. The only significant determinant of REE was muscle mass.
Conclusion
Patients had a higher REE adjusted for muscle mass than did controls, implying that they might be at a catabolic stage, and at risk of malnutrition. These findings indicate the need for determining body composition and for nutritional assessment and support in hemodialysis patients, even without indications of malnutrition.
∗Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
†Biomedical Sciences, Strathclyde University, Glasgow, Scotland, United Kingdom
‡Division of Nephrology, Laikon General Hospital, Athens, Greece
Address reprint requests to Maria Skouroliakou, PhD, Department of Nutrition and Dietetics, Harokopio University of Athens, Eleutheriou Venizelou 70, Athens GR 17.671, Greece.
This study took place at the Laikon General Hospital and the 401 General Military Hospital.
None of the authors had any financial or other conflicts of interest.
ABSTRACT