This review provides clinicians with a comprehensive overview of indirect calorimetry including the principles, methodology, technologic advancements, benefits, and challenges. Clinical applications for indirect calorimetry and the potential limitations are specifically addressed for both the inpatient and outpatient setting. Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings. The benefits of providing optimal nutrition for recovery from illness and chronic health management are well documented. Indirect calorimetry offers a scientifically-based approach to customize a patient's energy needs and nutrient delivery to maximize the benefits of nutrition therapy. With recent advances in technology, indirect calorimeters are easier to operate, more portable, and affordable. Increased utilization of indirect calorimetry would facilitate individualized patient care and should lead to improved treatment outcomes.

Indirect calorimetry: a practical guide for clinicians.

Intermittent dialysis therapy is used in chronic uremia to re-establish body water solute concentrations that cannot be achieved by the natural organ. In this sense, the dialyzer becomes an artificial kidney and it is through the transport of substances by this device that chemical and biophysical control consistent with continued survival is achieved. This chapter is organized as shown in Figure 1 and consists of two basic lines of development: 

1.

Consideration of the dialyzer and its operating principles,




2.

Application of mass balance principles to various solute systems and the effect of dialyzer use on solute control during intermittent dialysis therapy.

Principles and Biophysics of Dialysis

https://www.kidney-international.org/article/S0085-2538(15)32377-2/pdf

Leukopenia, hypoxia, and complement function with different hemodialysis membranes

The untoward effects of the anions of dialysis fluids

Alterations in respiratory drive, mechanics, muscle function, and gas exchange are frequent if not invariable consequences of uremia. Pulmonary dysfunction may be the direct result of circulating uremic toxins or may result indirectly from volume overload, anemia, immune suppression, extraosseous calcification, malnutrition, electrolyte disorders, and/or acid-base imbalances. The pulmonary system is unique because it is affected by the disease and its treatment. Acetate hemodialysis reduces alveolar ventilation and PaO2 due to extrapulmonic CO2 unloading. Peritoneal dialysis increases alveolar ventilation and intraperitoneal pressure. The latter leads to an elevated and lengthened diaphragm, a reduced functional residual capacity, basilar atelectasis, possible hypoxemia, and altered respiratory muscle function. In patients on chronic peritoneal dialysis, adaptations may occur that limit the reductions in lung volumes, PaO2, and respiratory muscle strength that are often observed during acute peritoneal dialysis. This review details how uremia and dialysis interact to alter pulmonary function.

Ledwith J

Papers

Hypoventilation and hypoxemia during hemodialysis: reflex response to removal of CO2 across the dialyzer.

Reflex hypoventilation and decreased arterial oxygen tension during ultrafiltration.

A comparison of the respiratory dynamics during hemodialysis using acetate and bicarbonate dialysate in a sorbent regenerative system.