Measureing resting energy expenditure in HD patients

Malnutrition is prevalent in chronic hemodialysis (HD) patients and is related to multiple factors; HD procedure itself has been suggested to be a catabolic factor. To examine the possible effect of HD on energy metabolism, resting energy expenditure (REE) and respiratory quotient (RQ) in twenty-three chronic HD patients were measured by using indirect calorimetry before, during and after HD of 4 hours duration. Age-, sex-, and body mass index-matched healthy volunteers were used as control subjects. There were no significant differences in REE and RQ between 2 measurement-days. REE at the start of HD was significantly lower in HD patients. REE did not change significantly during HD. RQ at the start of HD was significantly higher than that in the control. RQ decreased during HD. Then, patients were divided into 2 groups according to the changes in the dry weight (DW), being the patients who had gained DW (group A) and those who had lost DW (group B). REE at the start of HD in group A was significantly higher than that in group B, and RQ in group A at the start of HD was significantly lower. The rate of RQ showed a marked decrease during the dialysis in group B. REE has been become a useful marker for assessing the state of nutrition in HD patients. Moreover, it has the potential to become an index of energy prescriptions (IDPN; Intradialytic parenteral nutrition), facilitating effective nutrition guidance based on monitoring REE and RQ values.