Resting energy expenditure of children and adolescents undergoing hemodialysis.

Objective: We compared the resting energy expenditure (REE) of clinically stable children and adolescents on hemodialysis with that of healthy individuals, to investigate whether the current energy recommendations from the National Kidney Foundation/Kidney Disease Outcomes Initiative (NKF/DOQI) are adequate.

Patients And Methods: A cross-sectional study was conducted in 25 children and adolescents (15 male, SD 12.3 +/- 3.1 years old) undergoing hemodialysis (study group) under stable clinical conditions. Patients were pair-matched by sex and age with 25 healthy individuals (control group). The REE was measured by indirect calorimetry. Nutritional status was evaluated by body mass index Z-score, and growth deficit was evaluated by height-for-age Z-score. Body composition was assessed by dual-energy X-ray absorptiometry. The total energy expenditure (TEE) was estimated by multiplying the REE by the physical activity factor. The recommended dietary allowance (RDA) for daily energy intake was compared with the estimated TEE in the study group, considering children's age-specific height.

Results: All anthropometric parameters were significantly lower in the study group. Malnutrition and stunting were found in up to 56% and 60%, respectively, of the children in the study group. The absolute REE was significantly lower in the study group than in the control group (1,067 +/- 191 kcal/day vs 1,372 +/- 290 kcal/day, respectively, P < .01). However, when the REE was adjusted for its main determinant, ie, lean body mass, no significant difference was observed between groups (P = .12). In the study group, the RDA for energy was above the TEE in all age groups, and the mean percentage of RDA/TEE was 124.2% +/- 14.2%.

Conclusions: Children and adolescents on hemodialysis had an important deficit of energy and protein stores. The similar adjusted REE found between hemodialysis patients and their matched healthy pairs suggests that under stable clinical conditions, the REE of these subjects is normal. Moreover, the energy recommendation set by he NKF/DOQI is appropriate for this population.