Energy metabolism, body composition, and urea generation rate in hemodialysis patients

Hemodialysis (HD) adequacy is currently assessed using normalized urea clearance (Kt/V), although scaling based on Watson volume (V) may disadvantage women and men with low body weight. Alternative scaling factors such as resting energy expenditure and high metabolic rate organ mass have been suggested. The relationship between such factors and uremic toxin generation has not been established. We aimed to study the relationship between body size, energy metabolism, and urea generation rate. A cross-sectional cohort of 166 HD patients was studied. Anthropometric measurements were carried on all. Resting energy expenditure was measured by indirect calorimetry, fat-free mass by bio-impedance and total energy expenditure by combining resting energy expenditure with a questionnaire-derived physical activity data. High metabolic rate organ mass was calculated using a published equation and urea generation rate using formal urea kinetic modeling. Metabolic factors including resting energy expenditure, total energy expenditure and fat-free mass correlated better with urea generation rate than did Watson volume. Total energy expenditure and fat-free mass (but not Watson Volume) were independent predictors of urea generation rate, the model explaining 42% of its variation. Small women (