Inflammation is associated with increased energy expenditure in patients with chronic kidney disease.
BACKGROUND
Inflammation, a clinical condition observed in patients with chronic kidney disease (CKD), may be related to increased resting energy expenditure (REE).


OBJECTIVE
The main objective was to investigate the relation between inflammation and REE in patients with CKD who are not undergoing dialysis. We also aimed to analyze whether a decrease in C-reactive protein (CRP) would result in a reduction in REE.


METHODS
This study enrolled 132 patients with CKD who were not undergoing dialysis, who had creatinine clearance from 5 to 65 mL.min(-1).1.73 m(-2), and who were 53.6 +/- 16 y old; 82 (62.1%) were men. Twenty-nine patients had clinical signs of infection. REE was measured by using indirect calorimetry, and inflammation was evaluated by using high-sensitivity CRP measurement. Patients were divided according to tertiles of CRP with the following intertertile ranges: first tertile, CRP < or = 0.14 mg/dL (n = 43); second tertile, CRP 0.15-0.59 mg/dL (n = 46); and third tertile, CRP > or = 0.60 mg/dL (n = 43). REE was measured before and after treatment in 10 patients who had inflammation or infection.


RESULTS
After adjustment for age, sex, and lean body mass, the REE of the third (1395 kcal/d; P = 0.02) and second (1355 kcal/d; P = 0.04) tertiles was significantly higher than that of the first tertile (1286 kcal/d). In the multiple linear regression analysis (n = 132), the independent determinants of REE were lean body mass, CRP, and age (R2 = 0.55). After treatment of infection in a subgroup of 10 patients, it was observed that a significant reduction in CRP concentration was accompanied by a significant reduction of 174 +/- 165 kcal that accounted for 13% of the initial REE.


CONCLUSIONS
This study showed that inflammation is associated with increased REE in patients with CKD.
Utaka
Simone
S
Nutrition Program, Federal University of São Paulo, São Paulo, Brazil.
Avesani
Carla M
CM
Draibe
Sergio A
SA
Kamimura
Maria A
MA
Andreoni
Solange
S
Cuppari
Lilian
L
D000886:Anthropometry; D001481:Basal Metabolism / Q000502:physiology; D001823:Body Composition; D002097:C-Reactive Protein; D002153:Calorimetry, Indirect / Q000379:methods; D003404:Creatinine / Q000652:urine; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006706:Homeostasis; D006801:Humans; D007249:Inflammation / Q000378:metabolism* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment
D002097:C-Reactive Protein; D003404:Creatinine