Day and night changes in energy expenditure of patients on automated peritoneal dialysis

Julien Aniort,Christophe Montaurier,Anais Poyet,Nathalie Meunier,Aurélien Piraud,Didier Aguilera,Marc Bouiller,Ioana Enache,Youssef Ali,Christelle Jouve,Adeline Blot,Nicolas Farigon,Noël Cano,Yves Boirie,Rudy Richard,Anne Elisabeth Heng

doi:10.1016/j.clnu.2020.11.028

Abstract

Automated peritoneal dialysis (APD) treatment for end-stage kidney disease affords patients a degree of autonomy in everyday life. Clinical investigations of their energy expenditure (EE) are usually based on resting EE, which could mask day and night variations in EE. The aim of this study, therefore, was to compare the components of EE in APD patients and healthy control (C) subjects. Patients treated with APD for more than 3 months were compared with C volunteers matched for age and lean body mass (LBM). Biochemical analyses were performed and body composition was determined by DEXA to adjust EE to LBM. Total EE, its different components and respiratory quotients (RQ) were measured by a gas exchange method in calorimetric chambers. Spontaneous total and activity-related EE (AEE) were also measured in free-living conditions over 4 days by a calibrated accelerometer and a heart rate monitor. APD (n=7) and C (n=7) patients did not differ in age and body composition. REE did not differ between the two groups. However, prandial increase in EE adjusted for dietary energy intake was higher in APD patients (+57.5±12.71kcal/h) than in C subjects (+33.8±10.5kcal/h, p=0.003) and nocturnal decrease in EE tended to be lower in APD patients undergoing dialysis sessions (- 4.53±8.37kcal/h) than in subjects (- 11.8±7.69kcal/h, p=0.059). Resting RQ (0.91±0.09 vs 0.81±0.04, p=0.032) and nocturnal RQ (0.91±0.09 vs 0.81±0.04, p=0.032) were significantly higher in APD patients, indicating a preferential use of glucose substrate potentially absorbed across the peritoneum. AEE was lower in APD patients (595.9±383.2kcal/d) than in C subjects (1205.2±370.5kcal/d, p=0.011). In contrast, energy intakes were not significantly different (1986±465 vs 2083±377kcal/d, p=0.677). Although the two groups had identical resting EE, APD patients had a higher prandial increase in EE, a lower activity-related EE and higher resting and nocturnal RQ than healthy subjects.

Highlights

Peritoneal dialysis is one of the alternatives to hemodialysis and kidney transplantation for the management of end-stage renal disease patients
Peritoneal absorption of glucose from the dialysate causes an additional intake of energy which can promote the increase in fat mass and metabolic syndrome
The two groups did not differ in age, activity as assessed by the Baecke score, body weight (BW), height, body surface area, body mass index and the different parameters of body composition measured by DEXA scan

Summary

Introduction

Peritoneal dialysis is one of the alternatives to hemodialysis and kidney transplantation for the management of end-stage renal disease patients. Automated peritoneal dialysis (APD) is a variant in which the dialysate exchanges are carried out automatically by a cycler, usually at night. This makes it the technique of choice for autonomous patients wanting to have their day free. Peritoneal absorption of glucose from the dialysate causes an additional intake of energy which can promote the increase in fat mass and metabolic syndrome. This would apply in the event of reduced physical activity and a fortiori if the dialysis sessions take place at night [5]

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Conclusion