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 intake. In such patients low energy metabolism is expected. We hypothesized that inmaintenance hemodialysis patients there are two types of the energy metabolism, high and low. This study was aimed at finding the energy metabolism in maintenance hemodialysis patients, especially in those with poor nutritional status. Subjects were hemodialysis out-patients (34 males and20 females, meanage 59.1±10.7y). 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±0.2g/dL) in spite of the adequate protein intake (1.1±0.3g/kg per day). Only11%ofthesubjectshadappropriate 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 (plt0.01). The results suggest that maintenance hemodialysis patients with poor nutritional status may have low REE.