Cargando…
Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study
BACKGROUND: Estimating energy requirements (ER) is crucial for nutritional attention to chronic kidney disease (CKD) patients. Current guidelines recommend measuring ER with indirect calorimetry (IC) when possible. Due to clinical settings, the use of simple formulas is preferred. Few studies have m...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9161672/ https://www.ncbi.nlm.nih.gov/pubmed/35662942 http://dx.doi.org/10.3389/fnut.2022.881719 |
_version_ | 1784719534616215552 |
---|---|
author | Ramos-Acevedo, Samuel Rodríguez-Gómez, Luis López-Cisneros, Sonia González-Ortiz, Ailema Espinosa-Cuevas, Ángeles |
author_facet | Ramos-Acevedo, Samuel Rodríguez-Gómez, Luis López-Cisneros, Sonia González-Ortiz, Ailema Espinosa-Cuevas, Ángeles |
author_sort | Ramos-Acevedo, Samuel |
collection | PubMed |
description | BACKGROUND: Estimating energy requirements (ER) is crucial for nutritional attention to chronic kidney disease (CKD) patients. Current guidelines recommend measuring ER with indirect calorimetry (IC) when possible. Due to clinical settings, the use of simple formulas is preferred. Few studies have modeled equations for estimating ER for CKD. Nevertheless, variables of interest such as nutritional status and strength have not been explored in these models. This study aimed to develop and validate a model for estimating REE in patients with CKD stages 3–5, who were not receiving renal replacement therapy (RTT), using clinical variables and comparing it with indirect calorimetry as the gold standard. METHODS: In this study 80 patients with CKD participated. Indirect calorimetry (IC) was performed in all patients. The calorimeter analyzed metabolic measurements every minute for 15 min after autocalibration with barometric pressure, temperature, and humidity. Bioelectrical Impedance Analysis (BIA) was performed. Fat-free mass (FFM) was registered among other bioelectrical components. Handgrip strength (HGS) was evaluated and an average of 3 repetitions was recorded. Nutritional status was assessed with the subjective global assessment (SGA). Patients categorized as B or C were then considered as having malnutrition. RESULTS: We analyzed 71 patients and 3 models were generated. Model 1a included FFM; Model 2a included weight; Model 3c included handgrip strength (HGS). All other variables were stepwise, computer-selected with a p < 0.01 significance level; Malnutrition was consistently associated with ER among other clinical variables in all models (p < 0.05). The model that included BIA-FFM had R(2) (adjusted) = 0.46, while the model that included weight (Kg) had an adjusted R(2) (adjusted) = 0.44. The models had moderate concordance, LC = 0.60–0.65 with the gold standard, whereas other energy expenditure estimation equations had LC = 0.36 and 0.55 with indirect calorimetry. Using these previously validated equations as a reference, our models had concordance values ranging from 0.66 to 0.80 with them. CONCLUSION: Models incorporating nutritional status and other clinical variables such as weight, FFM, comorbidities, gender, and age have a moderate agreement with REE. The agreement between our models and others previously validated for the CKD patient is good; however, the agreement between the latter and IC measurements is moderate. The KDOQI lowest recommendation (25 Kcals/kg body weight) considering the 22% difference with respect to the IC for total energy expenditure rather than for REE. |
format | Online Article Text |
id | pubmed-9161672 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-91616722022-06-03 Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study Ramos-Acevedo, Samuel Rodríguez-Gómez, Luis López-Cisneros, Sonia González-Ortiz, Ailema Espinosa-Cuevas, Ángeles Front Nutr Nutrition BACKGROUND: Estimating energy requirements (ER) is crucial for nutritional attention to chronic kidney disease (CKD) patients. Current guidelines recommend measuring ER with indirect calorimetry (IC) when possible. Due to clinical settings, the use of simple formulas is preferred. Few studies have modeled equations for estimating ER for CKD. Nevertheless, variables of interest such as nutritional status and strength have not been explored in these models. This study aimed to develop and validate a model for estimating REE in patients with CKD stages 3–5, who were not receiving renal replacement therapy (RTT), using clinical variables and comparing it with indirect calorimetry as the gold standard. METHODS: In this study 80 patients with CKD participated. Indirect calorimetry (IC) was performed in all patients. The calorimeter analyzed metabolic measurements every minute for 15 min after autocalibration with barometric pressure, temperature, and humidity. Bioelectrical Impedance Analysis (BIA) was performed. Fat-free mass (FFM) was registered among other bioelectrical components. Handgrip strength (HGS) was evaluated and an average of 3 repetitions was recorded. Nutritional status was assessed with the subjective global assessment (SGA). Patients categorized as B or C were then considered as having malnutrition. RESULTS: We analyzed 71 patients and 3 models were generated. Model 1a included FFM; Model 2a included weight; Model 3c included handgrip strength (HGS). All other variables were stepwise, computer-selected with a p < 0.01 significance level; Malnutrition was consistently associated with ER among other clinical variables in all models (p < 0.05). The model that included BIA-FFM had R(2) (adjusted) = 0.46, while the model that included weight (Kg) had an adjusted R(2) (adjusted) = 0.44. The models had moderate concordance, LC = 0.60–0.65 with the gold standard, whereas other energy expenditure estimation equations had LC = 0.36 and 0.55 with indirect calorimetry. Using these previously validated equations as a reference, our models had concordance values ranging from 0.66 to 0.80 with them. CONCLUSION: Models incorporating nutritional status and other clinical variables such as weight, FFM, comorbidities, gender, and age have a moderate agreement with REE. The agreement between our models and others previously validated for the CKD patient is good; however, the agreement between the latter and IC measurements is moderate. The KDOQI lowest recommendation (25 Kcals/kg body weight) considering the 22% difference with respect to the IC for total energy expenditure rather than for REE. Frontiers Media S.A. 2022-05-18 /pmc/articles/PMC9161672/ /pubmed/35662942 http://dx.doi.org/10.3389/fnut.2022.881719 Text en Copyright © 2022 Ramos-Acevedo, Rodríguez-Gómez, López-Cisneros, González-Ortiz and Espinosa-Cuevas. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Nutrition Ramos-Acevedo, Samuel Rodríguez-Gómez, Luis López-Cisneros, Sonia González-Ortiz, Ailema Espinosa-Cuevas, Ángeles Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title | Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title_full | Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title_fullStr | Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title_full_unstemmed | Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title_short | Nutritional Status and Other Clinical Variables Are Associated to the Resting Energy Expenditure in Patients With Chronic Kidney Disease: A Validity Study |
title_sort | nutritional status and other clinical variables are associated to the resting energy expenditure in patients with chronic kidney disease: a validity study |
topic | Nutrition |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9161672/ https://www.ncbi.nlm.nih.gov/pubmed/35662942 http://dx.doi.org/10.3389/fnut.2022.881719 |
work_keys_str_mv | AT ramosacevedosamuel nutritionalstatusandotherclinicalvariablesareassociatedtotherestingenergyexpenditureinpatientswithchronickidneydiseaseavaliditystudy AT rodriguezgomezluis nutritionalstatusandotherclinicalvariablesareassociatedtotherestingenergyexpenditureinpatientswithchronickidneydiseaseavaliditystudy AT lopezcisnerossonia nutritionalstatusandotherclinicalvariablesareassociatedtotherestingenergyexpenditureinpatientswithchronickidneydiseaseavaliditystudy AT gonzalezortizailema nutritionalstatusandotherclinicalvariablesareassociatedtotherestingenergyexpenditureinpatientswithchronickidneydiseaseavaliditystudy AT espinosacuevasangeles nutritionalstatusandotherclinicalvariablesareassociatedtotherestingenergyexpenditureinpatientswithchronickidneydiseaseavaliditystudy |