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The effect of hemodialysis on balance measurements and risk of fall

  • Nephrology - Original Paper
  • Published:
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Abstract

Background

Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis.

Methods

Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis.

Results

Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement.

Conclusions

In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.

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References

  1. Stack AG, Molony DA, Rives T et al (2005) Association of physical activity with mortality in the US dialysis population. Am J Kidney Dis 45:690–701

    Article  PubMed  Google Scholar 

  2. Painter P, Marcus RL (2013) Assessing physical function and physical activity in patients with CKD. Clin J Am Soc Nephrol 8(5):861–872

    Article  PubMed  Google Scholar 

  3. Soangra R, Lockhart TE, Lach J et al (2013) Effects of hemodialysis therapy on sit-to-walk characteristics in end stage renal disease patients. Ann Biomed Eng 41(4):795–805

    Article  PubMed  Google Scholar 

  4. Mittalhenkle A, Gillen DL, Stehman-Breen CO (2004) Increased risk of mortality associated with hip fracture in the dialysis population. Am J Kidney Dis 44(4):672–679

    Article  PubMed  Google Scholar 

  5. Roberts RG, Kenny RA, Brierley EJ (2003) Are elderly haemodialysis patients at risk of falls and postural hypotension? Int Urol Nephrol 35(3):415–421

    Article  PubMed  Google Scholar 

  6. Sims RJ, Taylor R, Masud T et al (2007) The effect of a single haemodialysis session on functional mobility in older adults: a pilot study. Int Urol Nephrol 39(4):1287–1293

    Article  PubMed  Google Scholar 

  7. Kohen-Raz R (1991) Application of tetra-ataxiametric posturography in clinical and developmental diagnosis. Percept Mot Skills 73(2):635–656

    Article  CAS  PubMed  Google Scholar 

  8. Lord SR, Menz HB, Tiedemann A (2003) A physiological profile approach to falls risk assessment and prevention. Phys Ther 83(3):237–252

    PubMed  Google Scholar 

  9. National Kidney Foundation Hemodialysis Adequacy (2015) Work group KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis 66(5):884–930

    Article  Google Scholar 

  10. Delgado C, Johansen KL (2010) Deficient counseling on physical activity among nephrologists. Nephron Clin Pract 116(4):330–336

    Article  Google Scholar 

  11. Desmet C, Beguin C, Swine C et al (2005) Falls in hemodialysis patients: prospective study of incidence, risk factors, and complications. Am J Kidney Dis 45(1):148–153

    Article  PubMed  Google Scholar 

  12. Cook WL, Tomlinson G, Donaldson M et al (2006) Falls and fall-related injuries in older dialysis patients. Clin J Am Soc Nephrol 1(6):1197–1204

    Article  PubMed  Google Scholar 

  13. Alem AM, Sherrard DJ, Gillen DL et al (2000) Increased risk of hip fracture among patients with end-stage renal disease. Kidney Int 58:396–399

    Article  CAS  PubMed  Google Scholar 

  14. Lockhart TE, Barth AT, Zhang X et al (2010) Portable, non-invasive fall risk assessment in end stage renal disease patients on hemodialysis. ACM Trans Comput Hum Interact. doi:10.1145/1921081.1921092

    PubMed  PubMed Central  Google Scholar 

  15. Abdel-Rahman EM, Turgut F, Turkmen K et al (2011) Falls in elderly hemodialysis patients. QJM 104(10):829–838

    Article  CAS  PubMed  Google Scholar 

  16. Güler S, Bir LS, Akdag B et al (2012) The effect of pramipexole therapy on balance disorder and fall risk in Parkinson’s disease at early stage: clinical and posturographic assessment. ISRN Neurol 2012:320607

    Article  PubMed  PubMed Central  Google Scholar 

  17. Scott V, Votova K, Scanlan A et al (2007) Multifactorial and functional mobility assessment tools for fall risk among older adults in community, home-support, long-term and acute care settings. Age Ageing 36(2):130–139

    Article  PubMed  Google Scholar 

  18. Lord SR, Sambrook PN, Gilbert C et al (1994) Postural stability, falls and fractures in the elderly: results from the Dubbo Osteoporosis Epidemiology Study. Med J Aust 160(11):684–685

    CAS  PubMed  Google Scholar 

  19. Johansen K, Doyle J, Sakkas G et al (2005) Neural and metabolic mechanisms of excessive muscle fatigue in maintenance hemodialysis patients. Am J Physiol Regul Integr Comp Physiol 289(3):805–813

    Article  Google Scholar 

  20. Thompson CH, Kemp GJ, Taylor DJ et al (1993) Effect of chronic uraemia on skeletal muscle metabolism in man. Nephrol Dial Transpl 8(3):218–222

    CAS  Google Scholar 

  21. Anastasopoulos D, Kefaliakos A, Michalopoulos A (2011) Is plasma calcium concentration implicated in the development of critical illness polyneuropathy and myopathy? Crit Care 15(5):R247

    Article  PubMed  PubMed Central  Google Scholar 

  22. Annweiler C, Montero-Odasso M, Schott AM et al (2010) Fall prevention and vitamin D in the elderly: an overview of the key role of the non-bone effects. J Neuroeng Rehabil 7:50

    Article  PubMed  PubMed Central  Google Scholar 

  23. Halfon M, Phan O, Teta D (2015) Vitamin D: a review on its effects on muscle strength, the risk of fall, and frailty. Biomed Res Int 2015:953241

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gallagher JC, Rapuri P, Smith L (2007) Falls are associated with decreased renal function and insufficient calcitriol production by the kidney. J Steroid Biochem Mol Biol 103:610–613

    Article  CAS  PubMed  Google Scholar 

  25. Penninx BW, Pahor M, Cesari M, Woodman RC, Bandinelli S et al (2004) Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 52:719–724

    Article  PubMed  Google Scholar 

  26. Bennett L (2013) Patient independence in chronic kidney disease and anaemia: implications of the 2012 KDIGO guideline. J Ren Care 39(2):108–117

    Article  PubMed  Google Scholar 

  27. Coyne DW (2014) The KDOQI US commentary on KDIGO anemia guideline and quality of life. Am J Kidney Dis 63(3):540

    Article  PubMed  Google Scholar 

  28. Thompson CH, Kemp GJ, Taylor DJ, Ledingham JG, Radda GK, Rajagopalan B (1993) Effect of chronic uraemia on skeletal muscle metabolism in man. Nephrol Dial Transpl 8:218–222

    CAS  Google Scholar 

  29. Workgroup KD (2005) K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis 45(Suppl 3):S1–S153

    Google Scholar 

  30. Rocha A, Sousa C, Teles P et al (2015) Frequency of intradialytic hypotensive episodes: old problem, new insights. J Am Soc Hypertens 9(10):763–768

    Article  PubMed  Google Scholar 

  31. Farragher J, Rajan T, Chiu E et al (2016) Equivalent fall risk in elderly patients on hemodialysis and peritoneal dialysis. Perit Dial Int 36(1):67–70

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey

    Ertugrul Erken

  2. Department of Nephrology, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey

    Ruya Ozelsancak & Dilek Torun

  3. Department of Internal Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey

    Safak Sahin

  4. Department of Physical Therapy and Rehabilitation, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey

    Emine Ece Yılmaz & Berrin Leblebici

  5. Department of Biostatistics, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey

    Yunus Emre Kuyucu

  6. Department of Nephrology, Faculty of Medicine, Baskent University, Ankara, Turkey

    Siren Sezer

Authors
  1. Ertugrul Erken
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  2. Ruya Ozelsancak
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  3. Safak Sahin
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  4. Emine Ece Yılmaz
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  5. Dilek Torun
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  7. Yunus Emre Kuyucu
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Corresponding author

Correspondence to Ertugrul Erken.

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Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Human patients and healthy controls were tested, and the study was carried out with the informed consent from all participants.

Animal and human rights

The study did not involve any animal experiments or animal samples.

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Erken, E., Ozelsancak, R., Sahin, S. et al. The effect of hemodialysis on balance measurements and risk of fall. Int Urol Nephrol 48, 1705–1711 (2016). https://doi.org/10.1007/s11255-016-1388-7

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  • DOI: https://doi.org/10.1007/s11255-016-1388-7

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