Dietary energy requirements in relatively healthy maintenance hemodialysis patients estimated from long-term metabolic studies1

Background: Studies that examined dietary energy requirements (DERs) of patients undergoing maintenance hemodialysis (MHD) have shown mixed results. Many studies reported normal DERs, but some described increased energy needs. DERs in MHD patients have been estimated primarily from indirect calorimetry and from nitrogen balance studies. The present study measured DERs in MHD patients on the basis of their dietary energy intake and changes in body composition. Objective: This study assessed DERs in MHD patients who received a constant energy intake while changes in their body composition were measured. Design: Seven male and 6 female sedentary, clinically stable MHD patients received a constant mean (6SD) energy intake for 92.2 6 7.9 d while residing in a metabolic research ward. Changes in fat and fat-free mass, measured by dual-energy X-ray absorptiometry, were converted to calorie equivalents and added to energy intake to calculate energy requirements. Results: The average DER was 316 3 kcal $ kg $ d calculated from energy intake and change in fat and fat-free calories, which was 28 6 197 kcal/d over the 92 d of the study. DERs of MHD patients correlated strongly with their body weight (r = 0.81, P = 0.002) and less closely with their measured resting energy expenditure expressed as kcal/d (r = 0.69, P = 0.01). Although the average observed DER in MHD patients was similar to published estimated values for normal sedentary individuals of similar age and sex, there was wide variability in DER among individual patients (range: 26– 36 kcal $ kg $ d). Conclusions: Average DERs of sedentary, clinically stable patients receiving MHD are similar to those of sedentary normal individuals. Our data do not support the theory that MHD patients have increased DERs. Due to the high variability in DERs, careful monitoring of the nutritional status of individual MHD patients is essential. This trial was registered at clinicaltrials.gov as NCT02194114. Am J Clin Nutr 2016;103:757–65.