Only one-half of patients diagnosed with end-stage chronic kidney disease (CKD) in the U.S. survive more than three years after the initiation of renal replacement therapy like dialysis. One of the causes for this high mortality rate is protein-energy malnutrition, now termed protein-energy wasting (PEW), resulting from a myriad of factors related to the medical treatment and metabolic sequellae of the disease. Dr. Laura Byham-Gray, Professor of Nutritional Sciences at Rutgers University and registered dietitian and nutritionist with over 15 years of clinical experience, studies PEW and measures the energy expenditure (EE) of adults in hemodialysis to help patients maintain a stable nutritional status. Developing a predictive energy equation and validating it with rigorous research, Dr. Byham-Gray hopes to gain a deeper understanding of the disease management process, prevent malnutrition and metabolic abnormalities that arise from it, and improve treatments across the spectrum of chronic kidney disease.

In order to protect both the kidney and the nutritional health of patients diagnosed with CKD, Dr. Byham-Gray collaborates with interdisciplinary teams of nephrologists, nurses, physical therapists and nutritionists to examine PEW from the patient’s perspective so that her research agenda will make a significant contribution on what matters most for patients, such as living longer or living better. Some of the factors she looks into include total energy expenditure (TEE) and resting energy expenditure (REE) as measured by indirect calorimetry with the intent of precisely determining the amount of calories needed for rest as well as during routine physical activity and structured exercise to prevent compromise in the health condition. In this way, Dr. Byham-Gray is able to provide practitioners with potentially quick, reliable methods for measuring energy requirements in this vulnerable population. Chair of Macronutrients Work Group as part of the National Kidney Foundation and Academy of Nutrition and Dietetics and Chief Editor for Nutrition in Kidney Disease (2014), Dr. Byham-Gray is an influential figure in researching nutrient requirements that aid practitioners and advises practice guidelines that can be applied internationally. Currently, Dr. Byham-Gray and her team are very close to validating a predictive energy equation in hemodialysis that will have wide clinical utility, and plan to conduct similar studies in pediatrics, transplant, in earlier stages of kidney disease and acute kidney injury.

Current research includes:

• Protein-Energy Wasting: Dr. Byham-Gray studies how PEW is related to energy expenditure and studies the impact dialysis can have on the energy balance in patients with CKD. As current understandings of the metabolic demands theorized within this unique population are limited, studying this arena and developing an equation will help formulate more personalized prescriptions related to one of the main contributors for PEW like EE and ultimately have a positive impact on patient outcomes.
• PEW from Patient’s Perspective: Dr. Byham-Gray is studying PEW not only in terms of contributors but also from the patient’s perspective. What do they see as really putting them at risk or what has kept them from developing PEW? Taking a very patient-centered approach, Dr. Byham-Gray hopes to empower her patients to make changes in their management.
• Nutrition Therapy: In order to help CKD patients maintain a nutritional balance, Dr. Byham-Gray conducts studies in nutrition therapy to look at effective interventions that may help prevent PEW or other types of sequelae that occur secondary to the disease, e.g. bone and mineral disorders.