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Assessment of resting energy expenditure and identification of risk factors for hypermetabolism and hypometabolism in patients with acute kidney injury undergoing different types of dialysis

Grant number: 13/00315-1
Support Opportunities:Scholarships in Brazil - Doctorate
Effective date (Start): January 01, 2014
Effective date (End): July 31, 2016
Field of knowledge:Health Sciences - Medicine - Medical Clinics
Principal Investigator:Daniela Ponce
Grantee:Cassiana Regina de Góes
Host Institution: Faculdade de Medicina (FMB). Universidade Estadual Paulista (UNESP). Campus de Botucatu. Botucatu , SP, Brazil


Determination of resting energy expenditure (REE) is important to adjust the nutritional supply of individuals, particularly critically ill patients, allowing the planning of adequate nutrition to ensure their energy needs are met and to avoid the complications associated with over or underfeeding. The REE is influenced by several factors, such as gender, age, weight, height, ethnicity, and body composition in critically ill patients, in addition to these factors, there is the influence of disease and treatment effects. The Acute Renal Injury (AKI) is a complex disorder that occurs in a variety of situations, with clinical manifestations ranging from minimal elevations in serum creatinine to renal failure requiring dialysis. When the AKI is monofactorial and uncomplicated, REE apparently do not change, although the kidney is responsible for approximately 10% of REE. As important as the AKI own prognosis of these patients are comorbidities, prior nutritional status, complications such as infection, inflammation and ventilatory support, which alter the resting energy these patients. To date, no studies have evaluated the REE in patients with AKI on renal replacement therapy. The determination of REE in these patients, as well as the identification of factors that influence your metabolism are important to guide the prescription of nutrition therapy, preventing malnutrition and overfeeding, conditions that increase the morbidity and mortality in critically ill patients. The objectives of this study are to determine the REE of AKI patients treated by different types of dialysis and to identify factors associated with hyper-and hypometabolism in this population. This will be a prospective cohort study that will evaluate patients older than 18 years, admitted to the Hospital of the Faculty of Medicine of Botucatu and accompanied by the LRA Group in the Department of Nephrology, Department of Internal Medicine, for 24 consecutive months. This will include patients with AKI according to the AKIN criteria, with a clinical diagnosis of acute tubular necrosis (ATN), need for renal replacement therapy (AKIN stage 3), who are receiving enteral or parenteral nutrition, undergoing assessment nutritional monitoring and nephrology at least 2 days after starting dialysis. All patients included in the study will be followed by a clinical protocol consists of general data, nutritional data, evaluation of REE, biochemical test and evaluation of the infection. The REE is estimated by the Harris-Benedict and determined by Indirect Calorimetry (IC) before the start of dialysis and daily throughout the monitoring being performed, once per day when given continuous methods RRT and twice a day when methods indicated is intermittent (during and after dialysis). The IC will be performed by the equipment QUARK RMR of COSMED according manufacturer's instructions. The REE obtained by IC is classified as normal, low or increased, in accordance with the estimated REE. It is estimated that will be evaluated by the end of the study, approximately 120 patients undergoing 480 dialysis sessions . Monitoring will be terminated upon suspension of dialysis for renal function recovery or death of the patient. (AU)

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
DE GOES, CASSIANA R.; VOGT, BARBARA PEREZ; SANCHES, ANA CLAUDIA S.; BALBI, ANDRE L.; PONCE, DANIELA. Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU. Clinical Nutrition, v. 36, n. 4, p. 1170-1174, . (13/00315-1)
DE GOES, CASSIANA R.; BERBEL-BUFARAH, MARINA N.; SANCHES, ANA CLAUDIA S.; XAVIER, PATRICIA S.; BALBI, ANDRE L.; PONCE, DANIELA. Poor Agreement between Predictive Equations of Energy Expenditure and Measured Energy Expenditure in Critically Ill Acute Kidney Injury Patients. ANNALS OF NUTRITION AND METABOLISM, v. 68, n. 4, p. 276-284, . (13/00315-1)
DE GOES, CASSIANA R.; BALBI, ANDRE LUIS; PONCE, DANIELA. Evaluation of Factors Associated with Hypermetabolism and Hypometabolism in Critically Ill AKI Patients. NUTRIENTS, v. 10, n. 4, . (13/00315-1)
Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
GÓES, Cassiana Regina de. Rest energy expenditure assessment and identification of risk factors for hypermetabolism and hypometabolism in patients with acute kidney injury undergoing different types of dialysis. 2016. Doctoral Thesis - Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu Botucatu.

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