Abstract
Background: The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup.Methods: RMR and body composition (body cell mass (BCM) and fat mass) of 774 patients undergoing hemodialysis were estimated by bio-electrical impedance analysis (BIA). Anthropometric data were collected by a standard measurement protocol, and the upper arm muscle circumference (AMC) was calculated. Biochemical nutritional and dialysis parameters were obtained. Linear regression analysis was used to analyze the relationship among RMR, body composition and nutritional factors.Results: The mean age was 54.96 ± 15.78 years. RMR level in patients was 1463.0 (1240.5, 1669.0) kcal/d. In multiple linear regression models, BCM, left calf circumference (LCC), fat mass were the determinants association with RMR (P<0.001). Among the patients in the sample, 133 (17.2%) had been diagnosed with PEW per International Society of Renal Nutrition and Metabolism (ISRNM) criteria and 363 (46.9%) were being at risk PEW. The area under the receiver-operating characteristic curve (AUC) of RMR for predicting risk PEW was greater than RMR/BCM and RMR/body surface area (BSA). When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P<0.001). After adjustment for potential confounders, lowest RMR quartile level (<1239) increased the risk of PEW (OR = 4.71, 95% CI: 1.33–16.64, P=0.016) in all patients.Conclusions: Older patients with PEW have a lower RMR reduction. RMR and RMR/BCM may play the role in objective screening to detect risk PEW in MHD patients, especially in males.
Highlights
The kidney is an excretory organ, and an important energy metabolism organ [1]
133 cases (17.2%) were diagnosed with protein-energy wasting (PEW) per International Society of Renal Nutrition and Metabolism (ISRNM) criteria; 33.1% of cases were classified as having moderate risk of PEW and 13.8% of cases were classified as being at mild risk of PEW and
The distribution of water in the body will be significantly changed during malnutrition, which is often manifested as loss of intracellular fluid, increase of the ratio of extracellular to intracellular fluid.comprehensively considering fluid overload in hemodialysis patients [22], it is critical to evaluate the resting metabolic rate (RMR) level with bio-electrical impedance analyzer (BIA)
Summary
The kidney is an excretory organ, and an important energy metabolism organ [1]. Malnutrition and metabolic disorders, referred to as protein-energy wasting (PEW) are common clinical complications in patients with end-stage kidney disease (ESRD) [2,3]. 18–70% of maintenance hemodialysis (MHD) patients worldwide are suffering from PEW [4], and these data are up to 70–75% in China [5,6]. The main reason of MHD patients with PEW is energy imbalance resulted from malnutrition, inflammation and metabolic acidosis [7,8]. The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup. When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P
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