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When a patient plateaus or fails to respond, the question shouldn't be "increase the dose?" but "what has changed metabolically?" Measuring resting energy metabolism and substrate utilisation provides a prospective way to identify metabolic adaptation, personalise nutrition, preserve lean mass and guide treatment before outcomes deteriorate
But the same clinical trials also show that just under 14% dont lose weight, and some may even gain weight
reinardy, E
Thanks for this great review showing the need to move the paradigm away from just small solute clearance as a measure of PD prescribing
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