Chapter 5 - Energy metabolism and requirements in chronic kidney disease

Abstract

Chronic kidney disease (CKD) patients face challenges to their nutritional balance that adversely affects nutritional status. Protein-energy wasting and overweight/obesity are common and relate to energy imbalance. Regulation of energy balance, including energy intake, energy expenditure, and physical activity, is dependent on complex mechanisms that can be perturbed by the underlying causes of CKD and the therapies used in its treatment. Nutritional assessment includes the assessment of energy intake; however, underreporting dietary intake is common in CKD. Low physical activity is another challenge that affects energy balance. Studies on energy requirements have yielded mixed results, possibly as a consequence of large variabilities in clinical conditions and stage of disease. Disease-specific determinants of energy expenditure have been used to create predictive equations that more precisely establish energy needs in CKD. Nutrition management is one of the most important interventions to optimize nutritional status in CKD.