Patients receiving dialysis do not have increased energy needs compared with healthy adults

Background: Patients receiving dialysis are thought to have increased energy needs due to stress from the dialysis process or uraemic toxins. However, certain conditions may induce hypometabolic states potentially leading to unwanted weight gains when increased calorie intake is recommended. Objectives: Since there is conflicting research, this study aims to assess total energy expenditure (TEE) of patients receiving dialysis through analysis of resting energy expenditure (REE) and physical activity levels. Design: Comprehensive review of the current literature on REE and physical activity levels. Methods: Two electronic databases (PubMed and CINAHL) were searched using keywords to find papers published within the last 10 years for physical activity studies and within the last five years for REE. Inclusion criteria: Adults undergoing long-term dialysis treatments who do not have comorbidities that influence energy expenditure such as inflammation, hyperthyroidism or cancers. Participants were also required to ambulate without assistance. Results: Only seven of the 325 studies found were included in this review. Most studies were controlled trials with one being a prospective study. Patients receiving dialysis had rest energy expenditures comparable to healthy adults. There was not a consensus between studies as to which predictive energy equation produced accurate energy recommendations. Overall, patients receiving dialysis were significantly less active compared with healthy adults and this related to muscle mass. Conclusion: Patients receiving dialysis tend to be sedentary or lightly active and do not have increased energy expenditure compared with healthy adults. Therefore, stable patients should not be prescribed increased calorie intake.