Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU.
Currently, the execution of indirect calorimetry, which is considered the gold standard for measuring energy expenditure, is not indicate during dialysis, and it may interfere on nutritional therapy of these patients. This study aimed to evaluate the resting energy expenditure (REE) in patients with severe acute kidney injury treated by different modalities of dialysis and to identify whether dialysis influences on REE.



This was a prospective cohort study that evaluated patients admitted in intensive care units with diagnosis of acute kidney injury AKIN-3, mechanically ventilated, and submitted to conventional hemodialysis (CHD), extended hemodialysis (EHD) or high volume peritoneal dialysis (HVPD). Indirect calorimetry was performed at pre dialysis time and during the dialysis procedure. Parameters that could change REE were also evaluated.



One-hundred patients undergoing 290 dialysis sessions were evaluated, with mean age 60.3 ± 17 years, 69% were male and 74% have died. There was no significant difference between REE of predialysis time and during dialysis time (2156 ± 659 kcal vs. 2100 ± 634 kcal, respectively, p = 0.15). No difference was observed in the REE before and during dialysis of different modalities. There were no differences between parameters pre and during dialysis of each modality. There was only a difference in norepinephrine dose, which was higher in pre dialysis time in HVPD and EHD modalities, compared with CHD modality. Moreover, during dialysis time, EHD modality had significantly higher VAD compared to other dialysis modalities.



The three evaluated modalities did not change REE. Indirect calorimetry can be performed during dialysis procedures and there was no difference between ventilation parameters, sedatives use, body temperature and VAD in both moments.
Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Internal Medicine, Botucatu, São Paulo, Brazil. Electronic address: cassiana.goes@yahoo.com.br.
Cassiana R de
CR
Góes
Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Internal Medicine, Botucatu, São Paulo, Brazil.
Barbara Perez
BP
Vogt
Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Internal Medicine, Botucatu, São Paulo, Brazil.
Ana Claudia S
ACS
Sanches
Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Internal Medicine, Botucatu, São Paulo, Brazil.
André L
AL
Balbi
Faculdade de Medicina de Botucatu, UNESP Univ Estadual Paulista, Department of Internal Medicine, Botucatu, São Paulo, Brazil.
Daniela
D
Ponce
D058186:Acute Kidney Injury / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D001481:Basal Metabolism / Q000187:drug effects; D001831:Body Temperature; D001938:Brazil; D002153:Calorimetry, Indirect; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D010530:Peritoneal Dialysis / Q000009:adverse effects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D006993:Hypnotics and Sedatives; D014662:Vasoconstrictor Agents; D009638:Norepinephrine
Acute kidney injury; Dialisys; Energy expenditure; Indirect calorimetry; Intensive care