Risk of mortality in patients with end-stage renal disease: the role of malnutrition and possible therapeutic implications

Determinants of resting energy expenditure in hemodialysis patients, and comparison with healthy subjects

OBJECTIVE

This study evaluated the factors that affect the resting energy expenditure (REE) and nutritional status of hemodialysis patients, and to assess any differences with healthy subjects.

DESIGN

This was an observational case-control study.

SETTING

This study took place at the Hemodialysis Units of the Laikon General Hospital and 401 General Military Hospital (Athens, Greece).

PATIENTS

Twenty-five patients undergoing hemodialysis and 23 controls were recruited. Controls were healthy volunteers with no history of diseases or medication use. Patients with active infectious or inflammatory disease were excluded.

INTERVENTION

We measured REE using indirect calorimetry. Body composition as measured by Bioelectrical Impedance Analysis (BIA), anthropometry, and biochemical parameters were assessed in both groups.

MAIN OUTCOME MEASURE

Adjusted or unadjusted for muscle mass, REE was compared between the two groups. Multiple linear regression analysis was used to study independent determinants of REE.

RESULTS

Patients had no clinical signs of malnutrition. Resting energy expenditure was not different between the two groups, but REE adjusted for muscle mass was significanlty higher in hemodialysis patients. There were no differences in body composition, with the exception of muscle mass. Patients had lower muscle mass than controls, as determined by duration of disease. The only significant determinant of REE was muscle mass.

CONCLUSION

Patients had a higher REE adjusted for muscle mass than did controls, implying that they might be at a catabolic stage, and at risk of malnutrition. These findings indicate the need for determining body composition and for nutritional assessment and support in hemodialysis patients, even without indications of malnutrition.

Scope of Practice in Renal Nutrition

Clinical standards for practice in renal nutrition can vary dramatically from region to region, state to state, and clinic to clinic, and are greatly affected by the policies of several governing bodies. This review explores the factors that influence practice patterns among renal dietitians and examines the current American Dietetic Association's Scope of Dietetics Practice Framework for its applicability to kidney disease. Lastly, this article discusses current strategies for establishing a scope of practice in renal nutrition and evaluates licensure and credentialing issues that impact standards for practice across the various regions of the United States.