Low resting energy expenditure in middle-aged and elderly hemodialysis patients with poor nutritional status

Due to high resting energy expenditure REE in maintenance hemodialysis patients, an increase in energy intake is usually recommended to improve their nutritional status. However, some patients appear to have poor appetite and low energy in take. In such patients low energy metabolism is expected. We hypothesized that in maintenance hemodialysis patients there are two types of the energy metabolism, high and low. This study was aimed at finding the energy metabolismin maintenance hemodialysis patients, especially in those with poor nutritional status. Subjects were hemodialysis out-patients 34 males and 20 females, mean age 59.1 center dot 10.7y center dot REE was measured by an indirect calorimeter. Protein intake was obtained from normalized protein catabolic rate nPCR, and physical activity level PAL was obtained by time study. Nutritional status assessed by serum albumin concentration was poor 3.7 center dot 0.2g/dL in spite of theadequate proteinintake 1.1 center dot 0.3g/kgperday. Only11% of the subjects had appropriate serum albumin concentration. Mean REE was 24.6 kcal/kg per day which was lower than that of healthy Japanese 26.5kcal/kg per day. REE and PAL positively correlated with serum albumin concentration p<0.01. The results suggest that maintenance hemodialysis patients with poor nutritional status may have low REE.