Energy intake and expenditure profile in chronic peritoneal dialysis patients complicated with circulatory congestion.
BACKGROUND
Circulatory congestion is an adverse predictor of mortality in peritoneal dialysis (PD) patients.


OBJECTIVE
This study evaluated the nutritional status, energy intake, and expenditure profile of PD patients with and without previous circulatory congestion.


METHODS
We conducted a cross-sectional study in 244 PD patients, of whom 92 had previous circulatory congestion. We estimated dietary energy intake by using a locally validated 7-d food-frequency questionnaire and by assessing resting energy expenditure (REE) and total energy expenditure (TEE) with indirect calorimetry and a locally validated physical activity questionnaire, respectively.


RESULTS
In comparison with those without circulatory congestion, patients with previous circulatory congestion were more malnourished by subjective global assessment (59% compared with 36%; P < 0.001), had lower handgrip strength, had lower midarm muscle circumference, had lower dietary protein (0.98 +/- 0.45 compared with 1.19 +/- 0.44 g x kg(-1) x d(-1); P < 0.001), and had lower energy intake (92.5 +/- 37.0 compared with 110.9 +/- 35.7 kJ x kg(-1) x d(-1); P < 0.001) but had higher C-reactive protein (P = 0.025) and higher REE (P < 0.001). However, no difference in TEE was noted between the 2 groups, which indicated lower activity energy expenditure among patients with previous circulatory congestion. The resulting energy balance was significantly more negative for patients with previous circulatory congestion than for those without previous circulatory congestion (P = 0.050). Furthermore, the prevalence of malnutrition increased with increasing episodes of circulatory congestion (P = 0.017).


CONCLUSIONS
Patients with previous circulatory congestion had significantly more inflammation, more muscle wasting, and higher REE but lower activity energy expenditure and energy and protein intakes in keeping with an anorexia-cachexia syndrome. The mechanisms of increased REE and reduced energy intake among patients with previous circulatory congestion warrant further investigation.
Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. aymwang@hku.hk
Angela Yee-Moon
AY
Wang
Mandy Man-Mei
MM
Sea
Nelson
N
Tang
Christopher Wai-kei
CW
Lam
Iris Hiu-Shuen
IH
Chan
Siu-Fai
SF
Lui
John E
JE
Sanderson
Jean
J
Woo
D000293:Adolescent; D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D010530:Peritoneal Dialysis / Q000379:methods*; D012146:Rest; D012907:Smoking / Q000453:epidemiology