Avaliação do gasto energético de repouso e identificação de fatores de risco para hiper e hipometabolismo em pacientes com lesão renal aguda submetidos a diferentes tipos de diálise

Autor(es)

Cassiana Regina Góes

• Tipo de documento: Tese de Doutorado
• Imprenta: Botucatu. 2016-09-27.
• Instituição: Universidade Estadual Paulista (Unesp). Faculdade de Medicina. Botucatu
• Data de defesa: 2016-08-30
• Orientador: Daniela Ponce; André Luis Balbi

Resumo

Introduction: The appropriate nutritional support depends on the ability of nutritional therapy team to estimate the energy expenditure (EE) of more assertively. Indirect calorimetry (IC) is considered the gold standard method to measure EE in critically ill patients. Acute kidney injury (AKI) is a frequent complication in patients in intensive care unit (ICU) and the study of EE in these patients still very limited. So this study aimed to review the use of IC in critically ill patients, with emphasis in AKI patients, also assess, in three articles, the interference of dialysis modalities in IC measure, the prevalence of hyper- and hypometabolism and evolution of resting EE in patients with severe AKI in ICU. This was a prospective cohort study that evaluated patients admitted to the ICU with diagnosis of AKI, with IC performed at different times post indication of dialysis. Evaluating whether EE is changed by the dialysis procedure, we observed that the REE during dialysis session showed no significant difference compared to REE pré dialysis. Other evaluated parameters such as ventilation, presence of sedation, norepinephrine dose and body temperature also did not differ during dialysis. Since considering the categorization REE, hypermetabolic patients were 64 (62%), 42 were normometabólicos (34%) and 18 hipometabólicos (14%). Noradrenaline dose and age were independently associated with the presence of hypermetabolism. In 28 days survival analysis protein intake and vasoactive drugs (VAD) dose was associated with mortality. What about REE during follow-up, we observed that there was an increase in REE on 5 (2270 ± 556 kcal) compared to 2 and 3 (2022 ± 754, 2022 ± 660 kcal, respectively, p = 0.04). The variability of REE had a median of 0.44% (-14, 14), and it was positively correlated with minute volume, FiO2 and body temperature. Conclusion: IC can be performed during the dialysis procedure, without changes in the REE. Patients with severe AKI are mostly hypermetabolic, and hypermetabolism presence was associated with younger age and higher dose of VAD. They were identified as factors associated with death lower protein intake and higher dose of VAD, while hyper- and hypometabolism not associated with risk of death. Furthermore, dialysis patients with AKI show little variability in REE. The REE in these patients was associated independently with FiO2 minute ventilation and body temperature. (AU)

• Processo FAPESP: 13/00315-1 - Avaliação do gasto energético de repouso e identificação de fatores de risco para hiper e hipometabolismo em pacientes com lesão renal aguda submetidos a diferentes tipos de diálise
• Beneficiário: Cassiana Regina de Góes
• Modalidade de apoio: Bolsas no Brasil - Doutorado