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ORIGINAL RESEARCH COMMUNICATION |
1 From the Nutrition Program (SU and MAK), Division of Nephrology (CMA, SAD, and LC), and the Department of Preventive Medicine (SA), Federal University of São Paulo, São Paulo, Brazil
Background: Inflammation, a clinical condition observed in patients with chronic kidney disease (CKD), may be related to increased resting energy expenditure (REE).
Objectives: The main objective was to investigate the relation between inflammation and REE in patients with CKD who are not undergoing dialysis. We also aimed to analyze whether a decrease in C-reactive protein (CRP) would result in a reduction in REE.
Design: This study enrolled 132 patients with CKD who were not undergoing dialysis, who had creatinine clearance from 5 to 65 mL · min–1 · 1.73 m–2, and who were 53.6 ± 16 y old; 82 (62.1%) were men. Twenty-nine patients had clinical signs of infection. REE was measured by using indirect calorimetry, and inflammation was evaluated by using high-sensitivity CRP measurement. Patients were divided according to tertiles of CRP with the following intertertile ranges: first tertile, CRP 
0.14 mg/dL (n = 43); second tertile, CRP 0.15–0.59 mg/dL (n = 46); and third tertile, CRP 
0.60 mg/dL (n = 43). REE was measured before and after treatment in 10 patients who had inflammation or infection.
Results: After adjustment for age, sex, and lean body mass, the REE of the third (1395 kcal/d; P = 0.02) and second (1355 kcal/d; P = 0.04) tertiles was significantly higher than that of the first tertile (1286 kcal/d). In the multiple linear regression analysis (n = 132), the independent determinants of REE were lean body mass, CRP, and age (R2 = 0.55). After treatment of infection in a subgroup of 10 patients, it was observed that a significant reduction in CRP concentration was accompanied by a significant reduction of 174 ± 165 kcal that accounted for 13% of the initial REE.
Conclusion: This study showed that inflammation is associated with increased REE in patients with CKD.
Key Words: Chronic kidney disease • resting energy expenditure • inflammation • C-reactive protein • protein-energy malnutrition
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