Resting energy expenditure: Is there any difference between dialysis and non-dialysis dependent chronic kidney disease patients?

Abstract

Background

Energy imbalance can be caused by several clinical conditions commonly found in advanced CKD and end-stage renal disease (ESRD), resulting in nutritional deficiencies.

Objective

We aimed to investigate whether there is a difference in resting energy expenditure (REE) between patients with ESRD undergoing HD or PD and those with non-dialysis-dependent chronic kidney disease (NDD-CKD) and also to evaluate the relationship among REE and possible factors that might affect REE.

Methods

We included 29 patients undergoing HD, 29 patients undergoing PD, and 29 patients with stage 3–5 NDD-CKD. FFM was estimated using multifrequency bioimpedance analysis. REE was evaluated with indirect calorimetry. The serum level of Interleukin-6(IL-6) was measured using the chemiluminescence immunoassay technique. REE was normalized for FFM via the REE/FFM ratio.

Results

The study included 45(52%) females. A total of 87 patients were included in the study. The mean age of the patients was 50 ± 12 years. REE/FFM ratio was higher in the HD group than in the PD (p = 0.031) and NDD-CKD (p = 0.002) groups. IL-6 was higher in the HD group than the NDD-CKD group (p = 0.004) and similar in the HD and PD groups (p = 0.089). REE/FFM ratio was positively correlated with IL-6 (r = 0.47, p < 0.001). Age, IL-6, and HD predicted REE/FFM ratio (F = 7.763, p < 0.001). In the analysis performed by including HD and PD patients, gender and HD were effective in predicting REE/FFM ratio (F = 3.315, p = 0.011).

Conclusions

REE was to be higher in the HD group than in the PD and NDD-CKD groups. The fact that HD patients have a higher REE than the NDD-CKD group may be explained by the higher IL-6 level. Further studies are needed to identify factors that may cause HD patients to have a higher REE than PD patients.