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Disease-specific predictive formulas for energy expenditure in the dialysis population

Vilar, Enric; Machado, Ashwini; Garrett, Andrew; Kozarski, Robert; Machado, Aswini; Wellsted, David; Farrington, Ken

Authors

Enric Vilar

Ashwini Machado

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Dr Andrew Garrett A.Garrett@hull.ac.uk
Senior Lecturer in Exercise and Environmental Physiology

Robert Kozarski

Aswini Machado

David Wellsted

Ken Farrington



Abstract

Background Metabolic rate is poorly understood in advanced kidney disease, direct measurement being expensive and time-consuming. Predictive equations for Resting Energy Expenditure (REE) are needed based on simple bedside parameters. Algorithms derived for normal individuals may not be valid in the renal population. We aimed to develop predictive equations for REE specific for the dialysis population. Design 200 subjects on maintenance dialysis underwent a comprehensive metabolic assessment including REE from indirect calorimetry. Parameters predicting REE were identified, regression equations developed, and validated in 20 separate subjects. Results Mean REE was 1658±317 kCal/day (males) and 1380±287 kCal/day (females). Weight and height correlated positively with REE (r2=0.54 and 0.31) and age negatively above 65 years (r2=0.18). The energy cost of a unitary kg of body weight increased non-linearly for lower Body Mass Index. Existing equations derived in normal individuals underestimated REE (bias 50-114kCal/day for three equations). The novel derived equation was: REE(kCal/day)=-2.497∙Age∙Factorage+0.011∙height2.023+83.573∙Weight0.6291+68.171∙Factorsex where Factorage=1 if ≥65 years and zero if <65, Factorsex=1 if male, and zero if female. This algorithm performed at least as well as those developed for normal individuals in terms of limits of agreement and reduced bias. In validation with Bland-Altman technique, bias was not significant for our algorithm (-22±96kCal/day). 95% limits of agreement were +380 to -424 kCal/day. Conclusion Existing equations for REE derived from normal individuals are not valid in the dialysis population. The relatively increased REE in those with low BMI implies the need for higher dialysis doses in this subgroup. This disease-specific algorithm may be useful clinically and as a research tool to predict REE.

Publication Date 2014-07
Journal Journal of renal nutrition
Print ISSN 1051-2276
Electronic ISSN 1532-8503
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 24
Issue 4
Pages 243-251
Institution Citation Vilar, E., Machado, A., Garrett, A., Kozarski, R., Wellsted, D., & Farrington, K. (2014). Disease-specific predictive formulas for energy expenditure in the dialysis population. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation, 24(4), 243-251. https://doi.org/10.1053/j.jrn.2014.03.001
DOI https://doi.org/10.1053/j.jrn.2014.03.001
Keywords Dialysis; Kidney disease; REE
Publisher URL http://www.sciencedirect.com/science/article/pii/S1051227614000491
Additional Information Author's accepted manuscript of article published in: Journal of renal nutrition, 2014, v.24, issue 4 at http://www.sciencedirec...e/pii/S1051227614000491

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