Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study

Zanotto, Tobia; Mercer, Thomas H.; Linden, Marietta van der; Traynor, Jamie P.; Doyle, Arthur; Chalmers, Karen; Allan, Nicola; Shilliday, Ilona; Koufaki, Pelagia

doi:10.1016/j.gaitpost.2020.08.128

Cited by 16 publications

(12 citation statements)

References 25 publications

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“…This effect of HD was consistent with the results of other study (9) and it used a similar methodology. Unlike another study (18) which observed an increase in postHD lateral range associated with a higher risk of falls, in our study, we found no significant differences between cases and controls in postHD range and speed of CP movement, although the recorded instability remained higher among patients who had suffered falls. The fact that the increased postHD instability recorded among cases was not statistically significant for any of the stabilometric variables makes us think that the alterations that can result in falls do not improve in the periods between sessions.…”

Section: Discussioncontrasting

confidence: 99%

“…The stabilometry variables studied as factors were extracted from a stabilometry study conducted with hemodialized patients 6 months prior to this study and all the patients that composed this sample were included. In this stabilometry study, the balance of patients was tested before and after HD, following the same protocol for all patients, which had been used previously in a similar study ( 18 ) . The tests were carried out by two people trained to handle the platform in an office prepared for this purpose, where the lighting conditions were the same throughout the day.…”

Section: Methodsmentioning

confidence: 99%

“…In this stabilometry study, the balance of patients was tested before and after HD, following the same protocol for all patients, which had been used previously in a similar study (18) . The tests were carried out by two people trained to handle the platform in an office prepared for this purpose, where the lighting conditions were the same throughout the day.…”

Section: Variablesmentioning

confidence: 99%

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Factors associated with falls in hemodialysis patients: a case-control study

Pérez-Gurbindo

Álvarez-Méndez

Pérez‐García

et al. 2021

Rev. Latino-Am. Enfermagem

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Objective: to identify possible associations between a higher probability of falls among hemodialysis patients and laboratory values, comorbidities, pharmacological treatment, hemodynamic changes, dialysis results and stabilometric alterations. Method: this was a retrospective case-control study with hemodialysis patients. Patients in a hemodialysis unit who had suffered one or more falls were included in the case group. Patients from the same unit who had not suffered falls were the controls. Data were gathered from the patients’ clinical history and also from the results of a balance test conducted six months before the study. Results: thirty-one patients were included (10 cases and 21 controls). Intradialytic body weight change was significantly greater among cases (p <0.05). Patients in the case group also presented greater lateral instability after dialysis (p <0.05). Other factors such as high blood pressure, antihypertensives, beta-blockers, and lower heart rates were also associated with falls. Conclusion: a greater intradialytic weight change was associated with an increase in risk of falls. Nursing staff can control these factors to prevent the incidence of falls in dialysis patients.

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Section: Discussioncontrasting

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

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Factors associated with falls in hemodialysis patients: a case-control study

Pérez-Gurbindo

Álvarez-Méndez

Pérez‐García

et al. 2021

Rev. Latino-Am. Enfermagem

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“…We utilised a customised falls questionnaire to prospectively record falls for 12 months. A trained researcher administered this questionnaire to participants once a month, during their dialysis sessions [ 22 ]. Participants were classified at-risk of falling if they 1) experienced at least one fall during the prospective follow-up, or 2) reported at least two falls in the previous year [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study

et al. 2021

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Background Frailty is associated with multiple adverse outcomes in stage-5 chronic kidney disease (CKD-5) and upwards of one third of people receiving haemodialysis (HD) are frail. While many frailty screening methods are available in both uremic and non-uremic populations, their implementation in clinical settings is often challenged by time and resource constraints. In this study, we explored the diagnostic accuracy of time-efficient screening tools in people receiving HD. Methods A convenience sample of 76 people receiving HD [mean age = 61.1 years (SD = 14), 53.9% male] from three Renal Units were recruited for this cross-sectional study. Frailty was diagnosed by means of the Fried phenotype. Physical performance-based screening tools encompassed handgrip strength, 15-ft gait speed, timed up and go (TUG), and five-repetition sit to stand (STS-5) tests. In addition, participants completed the SF-36 Health Survey, the short-form international physical activity questionnaire and the Tinetti falls efficacy scale (FES) as further frailty-related measures. Outcome measures included the area under the curve (AUC), sensitivity, specificity, positive (PPV) and negative predictive values (NPV). The diagnostic performance of screening tools in assessing fall-risk was also investigated. Results Overall, 36.8% of participants were classified as frail. All the examined instruments could significantly discriminate frailty status in the study population. Gait speed [AUC = 0.89 (95%CI: 0.81–0.98), sensitivity = 75%, specificity = 93%] and TUG [AUC = 0.90 (95%CI: 0.80–0.99), sensitivity = 89%, specificity = 85%] exhibited the highest diagnostic accuracy. There was a significant difference in gait speed AUC (20%, p = 0.013) between participants aged 65 years or older (n = 36) and those under 65 years of age (n = 40), with better discriminating performance in the younger sub-group. The Tinetti FES was the only instrument showing good diagnostic accuracy (AUCs≥0.80) for both frailty (sensitivity = 82%, specificity = 79%) and fall-risk (sensitivity = 82%, specificity = 71%) screening. Conclusions This cross-sectional study revealed that time- and cost-efficient walking performance measures can accurately be used for frailty-screening purposes in people receiving HD. While self-selected gait speed had an excellent performance in people under 65 years of age, TUG may be a more suitable screening method for elderly patients (≥65 years). The Tinetti FES may be a clinically useful test when physical testing is not achievable.

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“…Recent studies suggest that patients with CKD are frailer (25) and have more fall risk factors, such as gait disorders (26), balance impairment (27,28), or cognitive impairment (29), already in the early stages of the renal disease; however, it is as of yet not clear whether HD itself represents a factor for higher fall risk. Although two recent studies have attempted to shed a light on the development of patients into frailty status in the first years of HD, analyzing fall rate (30) and physical performance (16), HD did not result to be the main cause of decreasing health status.…”

Section: Introductionmentioning

confidence: 99%

A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis

et al. 2022

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BackgroundPatients with end-stage renal disease are known to be particularly frail, and the cause is still widely seen as being directly related to specific factors in renal replacement therapy. However, a closer examination of the transitional phase from predialysis to long-term hemodialysis leads to controversial explanations, considering that the frailty process is already well-described in the early stages of renal insufficiency. This study aims to describe longitudinally and multifactorially changes in the period extending from the decision to start the replacement therapy through to the end of 2 years of hemodialysis. We hypothesized that frailty is pre-existent in the predialysis phase and does not worsen with the beginning of the replacement therapy. Between 2015 and 2018 we recruited 25 patients (72.3 ± 5.7 years old) in a predialysis program, with the expectation that replacement therapy would begin within the coming few months.MethodsThe patients underwent a baseline visit before starting hemodialysis, with 4 follow-up visits in the first 2 years of treatment. Health status, physical performance, cognitive functioning, hematology parameters, and adverse events were monitored during the study period.ResultsAt baseline, our sample had a high variability with patients ranging from extremely frail to very fit. In the 14 participants that did not drop out of the study, out of 32 clinical and functional measures, a statistically significant worsening was only observed in the Short Physical Performance Battery (SPPB) score (p < 0.01, F = 8.50) and the number of comorbidities (p = 0.01, F = 3.94). A careful analysis, however, reveals a quite stable situation in the first year of replacement therapy, for both frail and fit participants and a deterioration in the second year that in frail participants could lead to death.ConclusionOur results should stimulate a reassessment about the role of a predialysis program in reducing complications during the transitional phase, but also about frailty prevention programs once hemodialysis has begun, for both frail and fit patients, to maintain satisfactory health status.

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Association of postural balance and falls in adult patients receiving haemodialysis: A prospective cohort study

Cited by 16 publications

References 25 publications

Factors associated with falls in hemodialysis patients: a case-control study

Factors associated with falls in hemodialysis patients: a case-control study

Screening tools to expedite assessment of frailty in people receiving haemodialysis: a diagnostic accuracy study

A Pilot Observational Study Assessing Long-Term Changes in Clinical Parameters, Functional Capacity and Fall Risk of Patients With Chronic Renal Disease Scheduled for Hemodialysis

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