RESUMO
BACKGROUND AND OBJECTIVES: Studies show that inflammation can contribute to an increase in resting energy expenditure in patients with chronic kidney disease; however, findings about total energy expenditure (TEE) have not been reported. The aim of this study was to evaluate the effects of inflammation on TEE and physical activity energy expenditure in hemodialysis (HD) patients. DESIGN: This was a cross-sectional study. SETTING: This study was conducted from Hôpital Edouard Herriot, Lyon, France. PATIENTS: This study included 24 HD patients and 18 healthy subjects. MAIN OUTCOME MEASURE: TEE and step counts were measured over a 7-day period by the SenseWear Pro2 Armband in 24 HD patients (15 patients with C-reactive protein <5 mg/L, aged 67.0 ± 14.7 years, and 9 with C-reactive protein >5 mg/L, aged 69.0 ± 18.0 years) and compared with 18 healthy subjects (62.3 ± 15.3 years). RESULTS: Mean estimated TEE measured with SenseWear Pro2 Armband was significantly lower (25.5 ± 4.1 kcal/kg/day) in patients with inflammation when compared with those without inflammation (32.0 ± 6.7 kcal/kg/day) and with healthy subjects (31.8 ± 7.0 kcal/kg/day) (P = .012). There was a difference in the physical activity (step counts) between patient groups (P < .05). Healthy subjects and patients without inflammation walked more (8,107 ± 5,419 and 6,016 ± 3,752 steps/day, respectively) as compared with patients with inflammation (2,801 ± 2,754 steps/day, P = .001). CONCLUSION: Our findings suggest that patients with inflammation have a lower TEE when compared with healthy subjects and patients without inflammation. TEE is influenced by physical activity because patients with inflammation appear to be less active.
Assuntos
Metabolismo Energético , Inflamação/fisiopatologia , Falência Renal Crônica/fisiopatologia , Atividade Motora , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Proteína C-Reativa/análise , Calorimetria Indireta , Estudos de Casos e Controles , Estudos Transversais , Feminino , França , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Avaliação Nutricional , DescansoRESUMO
The accurate estimation of total daily energy expenditure (TEE) in chronic kidney patients is essential to allow the provision of nutritional requirements; however, it remains a challenge to collect actual physical activity and resting energy expenditure in maintenance dialysis patients. The direct measurement of TEE by direct calorimetry or doubly labeled water cannot be used easily so that, in clinical practice, TEE is usually estimated from resting energy expenditure and physical activity. Prediction equations may also be used to estimate resting energy expenditure; however, their use has been poorly documented in dialysis patients. Recently, a new system called SenseWear Armband (BodyMedia, Pittsburgh, PA) was developed to assess TEE, but so far no data have been published in chronic kidney disease patients. The aim of this review is to describe new measurements of energy expenditure and physical activity in chronic kidney disease patients.
Assuntos
Metabolismo Energético/fisiologia , Exercício Físico/fisiologia , Falência Renal Crônica/metabolismo , Avaliação Nutricional , Necessidades Nutricionais , Humanos , Valor Preditivo dos TestesRESUMO
La red de salud Tircel (multidisciplinaria y que combina la medicina pública y privada), está destinada a pacientescon insuficiencia renal crónica (IRC) de la ciudad de Lyon y comunidades adheridas, de la región Rhone- Alpes, Francia. Su función es coordinar la detección, el tratamiento y la prevención de la progresión de la IRC. Para ello, participa de acciones de formación de profesionales de la salud y de información al público y a los pacientes;también interviene en estudios de investigaciones médicas o socioeconómicas. El historial clínico de todos los pacientes adheridos está computadorizado, y los profesionalesactuantes tienen acceso al mismo a través de Internet. Se presentan en este estudio los resultados, al cabo de 3años de actividad de la misma. Se observó una disminución de la velocidad de progresión de la IRC, una mejorade la presión arterial diastólica y de los niveles de hemoglobina plasmática (estadísticamente significativos),y una tendencia a la disminución de la proteinuria). En el 82% de los pacientes la función renal (FR) (evaluadacomo aclaramiento de creatinina por fórmula de Cockroft y Gault) permaneció estable, en 10% disminuyó y en el 8% mejoró. En los pacientes que tuvieron al menos 4 valores informados de FR, la velocidad de pérdida de lamisma fue de 3.47 al/min./año en los 6 primeros meses, y de 0.13 ml/min./año a partir del año de seguimiento (p=0.026). El número de pacientes que recibieron medicamentos con acción sobre el eje renina angiotensina también se incrementó.Estos resultados confirman los efectos beneficiosos que resultan de estar adheridos a una red de salud destinada abrindar tratamiento por IRC.
An effective approach to the epidemic of chronic renal failure: a health network.The health network TIRCEL (multidisciplinary, that combinesprivate and public medicine structures) is directed to patients with chronic kidney disease (CKD); it is locatedin the city of Lyon and adhered communities, of Rhone- Alpes Region, Francia. The net mission is to coordinatethe detection, treatment and prevention of progression of CKD; to fulfill its mission, it is involved in actions directedto improve health professional formation, to inform the patients and the community, and to intervene in medicaland socio-economic research. The clinical data of all the adhered patients is computadorized, and can be accessedby the involved professional through Internet. After three years of running, a reduction in the speed of CKDs progression, as well as diastolic arterial pressure, and an increase in the levels of plasmatic hemoglobin (allstatistically significant) were observed. Renal function (RF) stayed without modifications in 82% of the patients,deteriorated in 10% and improved in 8%. In patients in whom, al least, 4 determinations of RF, estimated throughCockroft & Gault formula, were done, the deterioration was 3.47 ml/min/year during the first 6 months, and 0.13 ml/min/year alter 1 year of follow-up (p=0.026). A tendency to a reduction of proteinuria was observedtoo, as well as an increase in the number of patients that received drugs acting over the renin angiontensin axis.These facts confirmed the benefits obtained through patients adhesion to a multidisciplinary health net directedto the treatment of CKD.
Assuntos
Humanos , Insuficiência Renal Crônica , Progressão da DoençaRESUMO
La red de salud Tircel (multidisciplinaria y que combina la medicina pública y privada), está destinada a pacientescon insuficiencia renal crónica (IRC) de la ciudad de Lyon y comunidades adheridas, de la región Rhone- Alpes, Francia. Su función es coordinar la detección, el tratamiento y la prevención de la progresión de la IRC. Para ello, participa de acciones de formación de profesionales de la salud y de información al público y a los pacientes;también interviene en estudios de investigaciones médicas o socioeconómicas. El historial clínico de todos los pacientes adheridos está computadorizado, y los profesionalesactuantes tienen acceso al mismo a través de Internet. Se presentan en este estudio los resultados, al cabo de 3años de actividad de la misma. Se observó una disminución de la velocidad de progresión de la IRC, una mejorade la presión arterial diastólica y de los niveles de hemoglobina plasmática (estadísticamente significativos),y una tendencia a la disminución de la proteinuria). En el 82% de los pacientes la función renal (FR) (evaluadacomo aclaramiento de creatinina por fórmula de Cockroft y Gault) permaneció estable, en 10% disminuyó y en el 8% mejoró. En los pacientes que tuvieron al menos 4 valores informados de FR, la velocidad de pérdida de lamisma fue de ¹ 3.47 al/min./año en los 6 primeros meses, y de ¹ 0.13 ml/min./año a partir del año de seguimiento (p=0.026). El número de pacientes que recibieron medicamentos con acción sobre el eje renina angiotensina también se incrementó.Estos resultados confirman los efectos beneficiosos que resultan de estar adheridos a una red de salud destinada abrindar tratamiento por IRC. (AU)
An effective approach to the epidemic of chronic renal failure: a health network.The health network TIRCEL (multidisciplinary, that combinesprivate and public medicine structures) is directed to patients with chronic kidney disease (CKD); it is locatedin the city of Lyon and adhered communities, of Rhone- Alpes Region, Francia. The net mission is to coordinatethe detection, treatment and prevention of progression of CKD; to fulfill its mission, it is involved in actions directedto improve health professional formation, to inform the patients and the community, and to intervene in medicaland socio-economic research. The clinical data of all the adhered patients is computadorized, and can be accessedby the involved professional through Internet. After three years of running, a reduction in the speed of CKDs progression, as well as diastolic arterial pressure, and an increase in the levels of plasmatic hemoglobin (allstatistically significant) were observed. Renal function (RF) stayed without modifications in 82% of the patients,deteriorated in 10% and improved in 8%. In patients in whom, al least, 4 determinations of RF, estimated throughCockroft & Gault formula, were done, the deterioration was ¹ 3.47 ml/min/year during the first 6 months, and ¹ 0.13 ml/min/year alter 1 year of follow-up (p=0.026). A tendency to a reduction of proteinuria was observedtoo, as well as an increase in the number of patients that received drugs acting over the renin angiontensin axis.These facts confirmed the benefits obtained through patients adhesion to a multidisciplinary health net directedto the treatment of CKD. (AU)