Resting energy expenditure in pre‐dialysis diabetic patients

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Abstract
Background. The metabolic derangements of diabetes mellitus (DM) associated with those of chronic renal failure (CRF) may interfere with the energy and protein balance of patients with both diseases. The aim of this study was to verify whether the resting energy expenditure (REE) of non‐dialysis chronic renal failure diabetic patients differs from that of chronic renal failure patients without DM. Methods. REE was measured by indirect calorimetry in 24 CRF diabetic patients (CRF diabetes group), matched for age, gender, and degree of renal impairment to 24 CRF patients without DM (CRF control group). Results. The CRF diabetes group had a significantly higher REE (1538±230 kcal/day) than the CRF control group (1339±315 kcal/day, P=0.009). This difference was maintained even when the REE was adjusted for lean body mass (LBM; 30.3±4.3 vs 26.3±5.4 kcal/kg LBM/day, P=0.004). Mean protein intake was significantly higher in the CRF diabetes than in the CRF control group (0.89±0.20 vs 0.76±0.25 g/kg/day, P=0.02). Mean protein equivalent of nitrogen appearance (PNA) was also significantly higher in the CRF diabetes patients (1.21±0.31 vs 1.03±0.22 g/kg/day, P=0.02), reflecting a higher protein intake and/or elevated protein breakdown. Accordingly, REE was directly correlated with PNA mainly in the CRF diabetes group (r=0.57, P<0.003). Conclusion. Metabolic disturbances of poorly controlled DM may account for the higher REE observed in the CRF diabetes group. The role of the apparently higher protein breakdown in this increased REE remains to be clarified.