Energetic Profiles of Children with CKD Compared with Profiles of Healthy Controls

Background: Children with CKD who are obese develop earlier cardiovascular disease (CVD), a leading cause of mortality. Understanding how the components of energy balance, which include resting energy expenditure (REE), physical activity (PA) and energy intake, affect obesity in pediatric CKD is critical to prevent it and reduce CVD risk. Methods: Participants were 8-21 years old with CKD stages 3-5 not on dialysis or healthy controls (HC) of similar age, sex and BMI category. REE was measured by open circuit indirect calorimetry, PA by child PROMIS PA measure, energy intake by 24-hour dietary recall, and body composition by DXA. Linear regression models were used to determine if the components of energy balance differed between CKD and HC participants, adjusting for age and sex and for lean body mass (LBM), the primary determinant of REE, when evaluating group differences in REE. Results: Twenty-two participants with CKD and 14 HC completed baseline studies. REE was measured in 16/22 CKD and 10/14 HC participants. Self-reported PA levels and energy intake were similar between groups. After adjusting for age and sex, for a given LBM, REE was 116 kcal/day lower in CKD participants (p=0.026). Conclusion: Total energy intake and PA levels were similar between CKD and HC participants, but REE was significantly lower in the group with CKD, even after consideration for LBM. This suggests that energy imbalance in CKD may be related to lower-than-expected energy utilization by LBM. Funding: NIDDK SupportBaseline CharacteristicsResting Energy Expenditure Relative to LBM