Energy expenditure in chronic kidney disease patients.

OBJECTIVE: The assessment of energy expenditure in patients with chronic kidney disease (CKD) is a subject that has started to be investigated in the past 3 decades. This review will focus on studies that have assessed the energy expenditure of CKD predialysis and dialysis patients. Till date, most studies on this subject have focused on the assessment of resting energy expenditure (REE). In this regard, the current published data have demonstrated that clinically stable nondialysed CKD patients have REE similar or slightly lower than that of age- and gender-matched healthy individuals. For dialyzed patients, in both hemodialysis and peritoneal dialysis, the results are indicative that the REE of these patients is similar to that of age- and gender-matched healthy controls. The investigation of REE in specific catabolic conditions, such as poorly controlled diabetes, hyperparathyroidism, and inflammation, has shown that the REE in these catabolic conditions is increased. Additionally, it has also been reported that the hemodialysis procedure per se is also capable of enhancing the energy expenditure. The energy expenditure for physical activity is also an important component of energy expenditure and has been scarcely investigated in patients with CKD. The few studies that have investigated energy expenditure for physical activity have shown values lower than that of healthy sedentary individuals.
CONCLUSION: These results are highly suggestive that patients with CKD have a sedentary lifestyle. The effect of the present knowledge of energy expenditure on the energy requirements of the patients with CKD remains to be investigated in studies using gold standard methods for this purpose.