Comparison of resting energy equations and total energy expenditure in haemodialysis patients and body composition measured by multi‐frequency bioimpedance

Abstract

Most standard equations underestimate REE in HD patients compared to the HD Equation. TEE was greater in those with higher skeletal muscle mass and protein nitrogen appearance, lower co-morbidity, age, and dialysis vintage, and the employed. More metabolically active patients may require greater dialytic clearances.

Differences in the prevalence of sarcopenia in peritoneal dialysis patients using hand grip strength and appendicular lean mass: depends upon guideline definitions

“…Loss of muscle mass, often referred to as sarcopenia, is associated with an increased risk of mortality in the general population [1]. Patients with chronic kidney disease are at increased risk of muscle loss due to multiple factors, including dietary restrictions, metabolic acidosis, inflammation, urinary protein losses and reduced physical activity [2][3][4]. Additionally, peritoneal dialysis (PD) patients lose protein in the spent dialysate [5].…”

Indexing dialysis dose for gender, body size and physical activity: Impact on survival

“…REE and TEE reflect metabolic activity closely and hence, could also be considered as alternative scaling parameters [ 10 , 11 ]. REE and TEE are related to body composition, in particular lean body mass and skeletal muscle mass [ 12 , 13 ]. Increased energy expenditure is associated with higher levels of urea generation rate in haemodialysis (HD) patients [ 14 ].…”

Chapter 6 Adequacy of Haemodialysis in UK Adult Patients in 2016: National and Centre-specific Analyses

“…The older, more comorbid demographic of the current dialysis cohort may differ from previously studied populations although UKRR data has consistently, somewhat paradoxically, shown higher sessional urea clearance amongst older patients [15][16][17]. Muscle mass declines with age [15], and dialysis patients with less muscle mass are less physically active [16] and have lower energy expenditure [17]. So, one may have expected higher dialyser urea clearances delivered to the younger rather than older patients [18].…”

“…A minimum dialysis adequacy appears to be necessary for patient wellbeing [1], but the benefits of higher clearance and the optimal dialysis dose have not been well defined [2][3][4][5]. The older, more comorbid demographic of the current dialysis cohort may differ from previously studied populations although UKRR data has consistently, somewhat paradoxically, shown higher sessional urea clearance amongst older patients [15][16][17]. Muscle mass declines with age [15], and dialysis patients with less muscle mass are less physically active [16] and have lower energy expenditure [17].…”

“…Men and women differ in size, body composition and in their rates of resting energy expenditure all of which can contribute to lower dialyser urea clearance being needed in women to achieve a higher URR [16,18]. Observational studies and post hoc analyses of the HEMO study have suggested that women may benefit from a greater dialyser urea clearance than men [24,25], and for the same urea dialyser clearance women would receive a lower effective clearance [20].…”