HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: 90/5/1179    most recent ajcn.2009.28160v1 Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Wang, A. Y.-M. Articles by Woo, J. PubMed PubMed Citation Articles by Wang, A. Y.-M. Articles by Woo, J. Agricola Articles by Wang, A. Y.-M. Articles by Woo, J.

Energy intake and expenditure profile in chronic peritoneal dialysis patients complicated with circulatory congestion^1,2,3

¹ From the Departments of Medicine & Therapeutics (AY-MW, MM-MS, S-FL, JES, and JW) and Chemical Pathology (NT, CWL, and IH-SC), the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong; the Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology Foundation, Taipa, Macau (CWL); the Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong (AY-MW); and the Department of Cardiovascular Medicine, University of Birmingham, Edgbaston, Birmingham, United Kingdom (JES).

² Supported by the Hong Kong Health Service Research Fund, of which AY-MW is the principal investigator, and by the Bristol Myers Squibb Foundation (unrestricted grant in Nutrition, of which JW is the principal investigator).

³ Address correspondence to AY-M Wang, University Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong. E-mail: aymwang{at}hku.hk.

Background: Circulatory congestion is an adverse predictor of mortality in peritoneal dialysis (PD) patients.

Objective: This study evaluated the nutritional status, energy intake, and expenditure profile of PD patients with and without previous circulatory congestion.

Design: We conducted a cross-sectional study in 244 PD patients, of whom 92 had previous circulatory congestion. We estimated dietary energy intake by using a locally validated 7-d food-frequency questionnaire and by assessing resting energy expenditure (REE) and total energy expenditure (TEE) with indirect calorimetry and a locally validated physical activity questionnaire, respectively.

Results: In comparison with those without circulatory congestion, patients with previous circulatory congestion were more malnourished by subjective global assessment (59% compared with 36%; P < 0.001), had lower handgrip strength, had lower midarm muscle circumference, had lower dietary protein (0.98 ± 0.45 compared with 1.19 ± 0.44 g · kg^–1 · d^–1; P < 0.001), and had lower energy intake (92.5 ± 37.0 compared with 110.9 ± 35.7 kJ · kg^–1 · d^–1; P < 0.001) but had higher C-reactive protein (P = 0.025) and higher REE (P < 0.001). However, no difference in TEE was noted between the 2 groups, which indicated lower activity energy expenditure among patients with previous circulatory congestion. The resulting energy balance was significantly more negative for patients with previous circulatory congestion than for those without previous circulatory congestion (P = 0.050). Furthermore, the prevalence of malnutrition increased with increasing episodes of circulatory congestion (P = 0.017).

Conclusions: Patients with previous circulatory congestion had significantly more inflammation, more muscle wasting, and higher REE but lower activity energy expenditure and energy and protein intakes in keeping with an anorexia-cachexia syndrome. The mechanisms of increased REE and reduced energy intake among patients with previous circulatory congestion warrant further investigation.