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Shirai N, Usui N, Abe Y, Tamiya H, Amari T, Kojima S, Mikami K, Nagashima M, Shinozaki N, Shimano Y, Saitoh M. Relationship Among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis. Phys Ther 2024; 104:pzae064. [PMID: 38696344 DOI: 10.1093/ptj/pzae064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVE Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. METHODS A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. RESULTS A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. CONCLUSION FOF was associated with the incidence of falls in patients on hemodialysis. IMPACT The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.
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Affiliation(s)
- Nobuyuki Shirai
- Department of Rehabilitation, Niigata Rinko Hospital, Higashi-ku, Niigata City, Niigata, Japan
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
| | - Naoto Usui
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Physical Therapy, Kisen Hospital, Toganemachi, katsushika-ku, Tokyo, Japan
| | - Yoshifumi Abe
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Inariyama, Sayama City, Saitama, Japan
| | - Hajime Tamiya
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Physical Therapy, Niigata University of Health and Welfare, Shimami-cho, Kita-ku, Niigata City, Niigata, Japan
| | - Takashi Amari
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Physical Therapy, Health Science University, Kodachi, Fujikawaguchiko-machi, Minamitsuru-gun, Yamanashi, Japan
| | - Sho Kojima
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Physical Therapy, Kisen Hospital, Toganemachi, katsushika-ku, Tokyo, Japan
| | - Kenta Mikami
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Cardiac Rehabilitation, Iwatsuki Minami Hospital, Kuroya, Iwatsuki-ku, Saitama City, Saitama, Japan
| | - Mizuki Nagashima
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Cardiac Rehabilitation, Iwatsuki Minami Hospital, Kuroya, Iwatsuki-ku, Saitama City, Saitama, Japan
| | - Nobuhito Shinozaki
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Rehabilitation, Tokatsu Clinic Hospital, Hinoguchi, Matsudo City, Chiba, Japan
| | - Yu Shimano
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Rehabilitation, Saiyu Clinic, Sagamicyo, Koshigaya City, Saitama, Japan
| | - Masakazu Saitoh
- Renal Exercise and Physical Activity Network - Virtual Laboratory, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Hongo, Bunkyo-ku, Tokyo, Japan
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Shirai N, Yamamoto S, Osawa Y, Tsubaki A, Morishita S, Sugahara T, Narita I. Low muscle strength and physical function contribute to falls in hemodialysis patients, but not muscle mass. Clin Exp Nephrol 2024; 28:67-74. [PMID: 37773244 DOI: 10.1007/s10157-023-02403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Patients on hemodialysis (HD) have a higher incidence of fractures than the general population. Sarcopenia is frequently observed in patients on HD; however, the association of falls with sarcopenia and its diagnostic factors, including muscle mass, muscle strength, and physical function, are incompletely understood. METHODS This prospective cohort study was conducted at a single center. Sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Muscle mass was measured the bioelectrical impedance method. Grip strength was evaluated to assess muscle strength, while the Short Physical Performance Battery (SPPB) was used to assess physical function. Falls and their detailed information were surveyed every other week. RESULTS This study analyzed 65 HD patients (median age, 74.5 [67.5-80.0] years; 33 women [49.2%]). Sarcopenia was diagnosed in 36 (55.4%) patients. During the 1-year observation period, 31 (47.7%) patients experienced accidental falls. The falls group had lower median grip strength than the non-falls group (14.7 [11.4-21.8] kg vs. 22.2 [17.9-27.6] kg; p < 0.001). The median SPPB score was also lower in the falls versus non-falls group (7.0 [5.0-11.0] vs. 11.0 [8.0-12.0]; p = 0.009). In adjusted multiple regression analysis, diagnostic factors, including grip strength (B = 0.96, p = 0.04, R2 = 0.19) and SPPB (B = 1.11, p = 0.006, R2 = 0.23), but not muscle mass, were independently associated with fall frequency. CONCLUSIONS The frequency of falls in HD patients was related to muscle strength and physical function, but not muscle mass.
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Affiliation(s)
- Nobuyuki Shirai
- Department of Rehabilitation, Niigata Rinko Hospital, Niigata, Japan
| | - Suguru Yamamoto
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan.
| | - Yutaka Osawa
- Internal Medicine, Niigata Rinko Hospital, Niigata, Japan
| | - Atsuhiro Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University, Fukushima, Japan
| | - Tsubasa Sugahara
- Department of Rehabilitation, Niigata Bandai Hospital, Niigata, Japan
| | - Ichiei Narita
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
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Rodrigues RG, Dalboni MA, Correia MDA, Dos Reis LM, Moyses RMA, Elias RM. Calf Circumference Predicts Falls in Older Adults on Hemodialysis. J Ren Nutr 2023; 33:363-367. [PMID: 36155086 DOI: 10.1053/j.jrn.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/06/2022] [Accepted: 08/21/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. METHODS This is a prospective study that enrolled patients aged ≥65 years on conventional hemodialysis, followed for 6 months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34 cm for men and <33 cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). RESULTS Ninety-one patients were included (age 73.7 ± 5.4 years, 69.2% men, 56% with diabetes). Mean CC was 32.6 ± 3.7 cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P = .017 and P = .025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27 kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P = .037), higher age (HR 1.19, CI: 1.04-1.36, P = .011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P = .003) were independently associated with falls in a fully adjusted model. CONCLUSION CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.
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Affiliation(s)
| | | | | | - Luciene M Dos Reis
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosa M A Moyses
- LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil
| | - Rosilene M Elias
- Post Graduation, Universidade Nove de Julho (UNINOVE), Brazil; LIM-16, Faculdade de Medicina, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, Brazil.
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Shirai N, Inoue T, Ogawa M, Okamura M, Morishita S, Suguru Y, Tsubaki A. Relationship between Nutrition-Related Problems and Falls in Hemodialysis Patients: A Narrative Review. Nutrients 2022; 14:nu14153225. [PMID: 35956401 PMCID: PMC9370180 DOI: 10.3390/nu14153225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 01/12/2023] Open
Abstract
Falls are a social problem that increase healthcare costs. Hemodialysis (HD) patients need to avoid falling because fractures increase their risk of death. Nutritional problems such as frailty, sarcopenia, undernutrition, protein-energy wasting (PEW), and cachexia may increase the risk of falls and fractures in patients with HD. This review aimed to summarize the impact of frailty, sarcopenia, undernutrition, PEW, and cachexia on falls in HD patients. The reported global incidence of falls in HD patients is 0.85-1.60 falls per patient per year. HD patients fall frequently, but few reports have investigated the relationship between nutrition-related problems and falls. Several studies reported that frailty and undernutrition increase the risk of falls in HD patients. Nutritional therapy may help to prevent falls in HD patients. HD patients' falls are caused by nutritional problems such as iatrogenic and non-iatrogenic factors. Falls increase a person's fear of falling, reducing physical activity, which then causes muscle weakness and further decreased physical activity; this cycle can cause multiple falls. Further research is necessary to clarify the relationships between falls and sarcopenia, cachexia, and PEW. Routine clinical assessments of nutrition-related problems are crucial to prevent falls in HD patients.
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Affiliation(s)
- Nobuyuki Shirai
- Department of Rehabilitation, Niigata Rinko Hospital, Niigata 950-8725, Japan
| | - Tatsuro Inoue
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
- Correspondence: ; Tel.: +81-25-257-4443; Fax: +81-25-257-4443
| | - Masato Ogawa
- Division of Rehabilitation Medicine, Kobe University Hospital, Kobe 650-0017, Japan
| | - Masatsugu Okamura
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité–Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Shinichiro Morishita
- Department of Physical Therapy, School of Health Science, Fukushima Medical University, Fukushima 960-1295, Japan
| | - Yamamoto Suguru
- Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan
| | - Atsuhiro Tsubaki
- Department of Physical Therapy, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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Vanden Wyngaert K, Van Biesen W, Eloot S, Van Craenenbroeck AH, Calders P, Holvoet E. The importance of physical performance in the assessment of patients on haemodialysis: A survival analysis. PLoS One 2022; 17:e0268115. [PMID: 35588129 PMCID: PMC9119466 DOI: 10.1371/journal.pone.0268115] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background Physical performance is an important determinant of quality of life in patients on haemodialysis. An association between physical performance and survival could further enhance the importance of physical performance. We aimed to assess the association between different measures of physical performance and survival in dialysis patients. Methods 117 patients on haemodialysis were included from December 2016 and followed up to September 2020. Muscle strength (quadriceps, handgrip strength, and sit-to-stand), exercise capacity (six-minute walking test, 6MWT) and the risk of falls (Dialysis Fall Index, Tinetti, and Frailty and Injuries: Cooperative Studies of Intervention Techniques) were measured at the time of inclusion. Hospitalisation, morbidity (Davies Stoke index) and death were recorded. Data were analysed by least squares linear regression models and competing risks survival hazard models. Results During the observation period (median 33, min 30 max 45 months), 45 patients died (= 38.5%), resulting in a mortality rate of 15% per year. Cardiovascular disease (42.9%) was the most common cause of death. All domains of physical performance were associated with mortality, with the highest hazards for an increased risk of falls (Hazard Ratio (HR) = 20.4, p = 0.003) and poor exercise capacity (HR = 7.4, p<0.001). A score lower than 298 meters (specificity = 0.583; sensitivity = 0.889) on the 6MWT was established as a haemodialysis-specific cut-off point for mortality risk. Each increase in 6MWT (m) corresponded with a 0.4% decrease in mortality risk (HR = 0.996, 95%CI [0.994; 0.998]). The 6MWT as also associated with comorbidity (F-value = 6.1, p = 0.015). Physical performance was not associated with hospitalisation. Conclusions The 6MWT is associated with mortality in patients on haemodialysis and can be considered as a valid assessment tool to identify high-risk patients.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- * E-mail:
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
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Kono K, Moriyama Y, Yabe H, Hara A, Ishida T, Yamada T, Nishida Y. Relationship between malnutrition and possible sarcopenia in the AWGS 2019 consensus affecting mortality in hemodialysis patients: a prospective cohort study. BMC Nephrol 2021; 22:378. [PMID: 34772346 PMCID: PMC8588637 DOI: 10.1186/s12882-021-02566-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/13/2021] [Indexed: 11/21/2022] Open
Abstract
Background The first objective of this study was to determine the relationship between muscle strength or physical performance and mortality, and the second objective was to show the relationship of Geriatric Nutritional Risk Index (GNRI) to muscle strength and physical performance decline. Methods We examined handgrip, the 5-times chair stand test, and GNRI in 635 maintenance hemodialysis patients and followed up for 72 months. Predictors for all-cause death were examined using Kaplan-Meier analysis and Cox proportional analysis. The relationship between possible sarcopenia and nutritional disorder (GNRI) was constructed receiver operating characteristic (ROC) curve. We used the Youden index to determine the optimal cutoff points for GNRI. Results The multivariate Cox proportional hazard analysis revealed that the GNRI did not show any significance, although handgrip (HR 3.61, 95% CI 1.70–7.68, p < 0.001) and the 5-times chair stand test (HR 1.71 95% CI 1.01–2.90, p = 0.045) were significant predictors for mortality. On the evaluation of possible sarcopenia by handgrip strength, the area under curve (AUC) on ROC curve analysis were 0.68 (95% CI 0.64–0.72), and 5-chair stand, the AUC on ROC were 0.55 (95% CI 0.51–0.60). The cut-off value for the GNRI discriminating those at possible sarcopenia by handgrip strength based on the Youden index was 91.5. Conclusions Our study suggests that the handgrip strength test of the AWGS 2019 sarcopenia consensus was a simple and useful tool to predict mortality in chronic hemodialysis patients. Furthermore, GNRI assessment can be a useful tool for screening before assessing possible sarcopenia when it is difficult to perform SARC-F to all patients.
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Affiliation(s)
- Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare Graduate School, -3 Kozunomori, Narita, Chiba, 286-8686, Japan.
| | - Yoshifumi Moriyama
- Department of Rehabilitation, Kaikoukai Nagoya Kyoritsu Hospital, Nagoya, Aichi, Japan
| | - Hiroki Yabe
- Department of Physical Therapy, Seirei Christopher University. School of Rehabilitation, Hamamatsu, Shizuoka, Japan
| | - Ayaka Hara
- Dialysis division at Shizuoka, Kaishokai, Shizuoka, Shizuoka, Japan
| | - Takeki Ishida
- Department of Physical Therapy, International University of Health and Welfare Graduate School, -3 Kozunomori, Narita, Chiba, 286-8686, Japan
| | - Tetsuya Yamada
- Dialysis division, Kaikoukai Healthcare Group, Nagoya, Aichi, Japan
| | - Yusuke Nishida
- Department of Physical Therapy, International University of Health and Welfare Graduate School, -3 Kozunomori, Narita, Chiba, 286-8686, Japan
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Vanden Wyngaert K, Celie B, Calders P, Eloot S, Holvoet E, Van Biesen W, Van Craenenbroeck AH. Markers of protein-energy wasting and physical performance in haemodialysis patients: A cross-sectional study. PLoS One 2020; 15:e0236816. [PMID: 32730305 PMCID: PMC7392314 DOI: 10.1371/journal.pone.0236816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/14/2020] [Indexed: 01/01/2023] Open
Abstract
Background Physical impairments are common in uraemia, as reflected by the high risk of falls of haemodialysis (HD) patients. Furthermore, these patients often suffer from malnutrition. Objective Up to now, it is unknown which aspects of physical performance are predominantly driven by malnutrition in HD patients. As this answer could steer different interventions, the aim of this study was to evaluate the cross-sectional relationship between nutritional status, muscle strength, exercise capacity and the risk of falls. Methods This study recruited HD patients between December 2016 and March 2018 from two hospital-based and five satellite dialysis units (registration number on clinicaltrial.gov: NCT03910426). The mini-nutritional assessment scale as well as objective measures of protein-energy wasting were obtained (total iron-binding capacity, total protein levels, and CRP). Physical assessment included muscle strength (quadriceps, handgrip force, and sit-to-stand test), exercise capacity (six-minute walking test) and the risk of falls (Tinetti, FICSIT, and dialysis fall index). Their interrelationship was analysed by ridge regression models. Results Out of 113 HD patients (mean age 67 years ± 16.1, 57.5% male) 36.3% were malnourished according to the mini-nutritional assessment scale and a majority had impaired quadriceps force (86.7%), six-minute walking test (92%), and an increased risk of falls (73.5%). Total protein and CRP levels were identified as relevant nutritional factors in the association with physical performance. Nutritional parameters explained 9.2% of the variance in the risk of falls and 7.6% of the variance in exercise capacity. No conclusive association was found between nutritional status and muscle strength. Conclusion Protein-energy wasting is a determinant of the risk of falls and exercise capacity in patients on HD. The association between malnutrition and muscle weakness remains inconclusive.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Bert Celie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Amaryllis H. Van Craenenbroeck
- Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
- * E-mail:
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Abstract
PURPOSE OF REVIEW Hypertension (HTN) and chronic kidney disease (CKD) are significant problems. With recent advances in technologies, biosensors have shown a great potential to provide better home monitoring in hypertension (HTN), medication compliance, diagnostic device for kidney disease, CKD/end-stage renal disease (ESRD) care, and post kidney transplant management. RECENT FINDINGS Multiple devices/biosensors have been developed related to HTN, kidney function including real-time glomerular filtration rate, CKD/end-stage renal disease, and transplant care. In recent advances in wearable biosensors, point of care monitoring system could provide more integrated care to the patients via telenephrology. SUMMARY This review focuses on the recent advances in biosensors which may be useful for HTN and nephrology. We will discuss future potential clinical implication of these biosensors.
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The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: a prospective cohort study. BMC Nephrol 2020; 21:99. [PMID: 32169050 PMCID: PMC7071740 DOI: 10.1186/s12882-020-01759-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/05/2020] [Indexed: 02/07/2023] Open
Abstract
Background Stage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls. Previous research has shown that frailty is one of the primary contributors to the increased risk of falling in this clinical population. However, HD patients often present with abnormalities of cardiovascular function such as baroreflex impairment and orthostatic dysregulation of blood pressure (BP) which may also be implicated in the aetiology of falling. Therefore, we aimed to explore the relative importance of frailty and cardiovascular function as potential exercise-modifiable predictors of falls in these patients. Methods Ninety-three prevalent CKD-5 patients on HD from three Renal Units were recruited for this prospective cohort study, which was conducted between October 2015 and August 2018. At baseline, frailty status was assessed using the Fried’s frailty phenotype, while physical function was evaluated through timed up and go (TUG), five repetitions chair sit-to-stand (CSTS-5), objectively measured physical activity, and maximal voluntary isometric strength. Baroreflex and haemodynamic function at rest and in response to a 60° head-up tilt test (HUT-60°) were also assessed by means of the Task Force Monitor. The number of falls experienced was recorded once a month during 12 months of follow-up. Results In univariate negative binomial regression analysis, frailty (RR: 4.10, 95%CI: 1.60–10.51, p = 0.003) and other physical function determinants were associated with a higher number of falls. In multivariate analysis however, only worse baroreflex function (RR: 0.96, 95%CI: 0.94–0.99, p = 0.004), and orthostatic decrements of BP to HUT-60° (RR: 0.93, 95%CI: 0.87–0.99, p = 0.033) remained significantly associated with a greater number of falls. Eighty falls were recorded during the study period and the majority of them (41.3%) were precipitated by dizziness symptoms, as reported by participants. Conclusions This prospective study indicates that cardiovascular mechanisms implicated in the short-term regulation of BP showed a greater relative importance than frailty in predicting falls in CKD-5 patients on HD. A high number of falls appeared to be mediated by a degree of cardiovascular dysregulation, as evidenced by the predominance of self-reported dizziness symptoms. Trial registration ClinicalTrials.gov (trial registration ID: NCT02392299; date of registration: March 18, 2015).
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Vanden Wyngaert K, Van Craenenbroeck AH, Eloot S, Calders P, Celie B, Holvoet E, Van Biesen W. Associations between the measures of physical function, risk of falls and the quality of life in haemodialysis patients: a cross-sectional study. BMC Nephrol 2020; 21:7. [PMID: 31906987 PMCID: PMC6945514 DOI: 10.1186/s12882-019-1671-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 12/23/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Impaired physical function due to muscle weakness and exercise intolerance reduces the ability to perform activities of daily living in patients with end-stage kidney disease, and by consequence, Health-Related Quality of Life (HRQoL). Furthermore, the risk of falls is an aggregate of physical function and, therefore, could be associated with HRQoL as well. The present study examined the associations between objective and subjective measures of physical function, risk of falls and HRQoL in haemodialysis patients. METHODS This cross-sectional multicentre study included patients on maintenance haemodialysis. Physical function (quadriceps force, handgrip force, Sit-to-Stand, and six-minute walking test), the risk of falls (Tinetti, FICSIT-4, and dialysis fall index) and HRQoL (PROMIS-29 and EQ-5D-3 L) were measured and analysed descriptively, by general linear models and logistic regression. RESULTS Of the 113 haemodialysis patients (mean age 67.5 ± 16.1, 57.5% male) enrolled, a majority had impaired quadriceps force (86.7%) and six-minute walking test (92%), and an increased risk of falls (73.5%). Whereas muscle strength and exercise capacity were associated with global HRQoL (R2 = 0.32) and the risk of falls, the risk of falls itself was related to psycho-social domains (R2 = 0.11) such as depression and social participation, rather than to the physical domains of HRQoL. Objective measures of physical function were not associated with subjective fatigue, nor with subjective appreciation of health status. CONCLUSIONS More than muscle strength, lack of coordination and balance as witnessed by the risk of falls contribute to social isolation and HRQoL of haemodialysis patients. Mental fatigue was less common than expected, whereas, subjective and objective physical function were decreased.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology, University Hospitals Leuven, Leuven, Belgium.,Laboratory of Experimental Medicine and Paediatrics, University of Antwerp, Antwerp, Belgium
| | - Sunny Eloot
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Bert Celie
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Els Holvoet
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Ghent, Belgium
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