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Jesus LADSD, Pinheiro BV, Lucinda LMF, de Oliveira GBGR, Haddad MFPD, Vidigal ABR, Maciel JM, Watanabe LD, Oliveira CC, Reboredo MM. Factors associated with postural balance in patients with end-stage renal disease on hemodialysis. Clin Biomech (Bristol, Avon) 2023; 107:106033. [PMID: 37352608 DOI: 10.1016/j.clinbiomech.2023.106033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 04/18/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Patients with end-stage renal disease on hemodialysis have postural balance impairments due to uremic syndrome and hemodialysis complications. This study evaluated the factors associated with postural balance in patients on hemodialysis. METHODS This cross-sectional study included patients on hemodialysis [n = 93, 62.0 (16.0) years]. Postural balance was evaluated using a force plate in a static position with eyes opened and eyes closed on a firm surface and with eyes opened on a foam surface to register the center of pressure path length. Physical function was assessed by isometric handgrip force, the 5-repetition sit-to-stand test, and gait speed. The level of physical activity and quality of life were evaluated by accelerometry and the 36-Item Short Form Health Survey, respectively. FINDINGS After adjustment for potential confounders, the multiple linear regression analysis showed that the presence of diabetes mellitus and neurological disease and gait speed were significantly associated with the center of pressure path length in the eyes opened test (R2 = 0.263; p < 0.001). The center of pressure path length in the eyes closed test was significantly associated with the presence of neurological disease (R2 = 0.177; p = 0.002). The center of pressure path length in the eyes opened on a foam surface test was significantly associated with the presence of diabetes mellitus (R2 = 0.223; p < 0.001). INTERPRETATION Poor postural balance was associated with the presence of diabetes mellitus and neurological disease and a slower gait speed in patients on hemodialysis.
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Affiliation(s)
| | - Bruno Valle Pinheiro
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | - Leda Marília Fonseca Lucinda
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; Barbacena School of Medicine, Barbacena, Minas Gerais, Brazil; Department of Morphology, Institute of Biological Sciences, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
| | | | | | | | | | | | - Cristino Carneiro Oliveira
- Department of Physiotherapy, Federal University of Juiz de Fora - Governador Valadares, Governador Valadares, Minas Gerais, Brazil; School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maycon Moura Reboredo
- Pulmonary and Critical Care Division, University Hospital of Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil; School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil.
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Wang HH, Wu JL, Lee YC, Ho LC, Chang MY, Liou HH, Hung SY. Risk of Serious Falls Between Hemodialysis and Peritoneal Dialysis Patients: A Nationwide Population-based Cohort Study. Sci Rep 2020; 10:7799. [PMID: 32385311 PMCID: PMC7211016 DOI: 10.1038/s41598-020-64698-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 04/20/2020] [Indexed: 02/08/2023] Open
Abstract
The association between serious falls and dialysis modality [hemodialysis (HD) and peritoneal dialysis (PD)] is unclear. A nationwide population-based retrospective cohort study with 127,823 end-stage renal disease patients aged over 18 years was conducted with the unmatched cohort of 101,304 HD and 7,584 PD patients retrieved from Taiwan's National Health Insurance Research Database during 2000-2013. A total of 7,584 HD and 7,584 PD patients matched at 1:1 ratio by propensity score were enrolled to the study. Serious falls were defined by the diagnostic codes, E code, and image studies. Cox regression model and competing-risk model were used for statistical analysis. HD patients were older and had more comorbidities at baseline than PD patients. After matching and adjustment, HD patients had a higher risk of serious falls than PD patients [sHR 1.27 (95% CI 1.06-1.52)]. Females, elders, a history of falls before dialysis, comorbidity with stroke or visual problems, using diuretics, α-blockers, and mydriatics were associated with higher risks of serious falls among dialysis patients. The risk of serious falls was higher in HD patients than PD patients. Health professionals should create age-friendly environments, reduce unnecessary medications, and raise patients' awareness of falls in daily life.
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Affiliation(s)
- Hsi-Hao Wang
- Division of Nephrology, Department of Internal medicine, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Medical Quality, E-DA Hospital, Kaohsiung, Taiwan
| | - Jia-Ling Wu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Che Lee
- School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal medicine, E-DA Dachang Hospital, Kaohsiung, Taiwan
| | - Li-Chun Ho
- Division of Nephrology, Department of Internal medicine, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan.,Division of General Medicine, Department of Internal medicine, E-DA Hospital, Kaohsiung, Taiwan
| | - Min-Yu Chang
- Division of Nephrology, Department of Internal medicine, E-DA Hospital, Kaohsiung, Taiwan.,School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hung-Hsiang Liou
- Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan
| | - Shih-Yuan Hung
- Division of Nephrology, Department of Internal medicine, E-DA Hospital, Kaohsiung, Taiwan. .,School of Medicine, I-Shou University, Kaohsiung, Taiwan.
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Tekkarismaz N, Doruk Analan P, Ozelsancak R, Torun D, Caliskan K, Haberal M. Effect of Kidney Transplant on Balance and Fall Risk. EXP CLIN TRANSPLANT 2020; 18:73-77. [PMID: 32008501 DOI: 10.6002/ect.tond-tdtd2019.p19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Kidney transplant offers an improved quality of life and prolonged survival for patients with end-stage renal disease. This study aimed to compare balance and fall risk between kidney transplant recipients and healthy adults and to determine the relationship between biochemical parameters and fall risk and balance in kidney transplant recipients. As far as we know, this is the first study in the literature that evaluated whether balance changes occur in kidney transplant recipients using the Tetrax Interactive Balance System (Sunlight Medical Ltd., Ramat Gan, Israel). MATERIALS AND METHODS Our study included 131 kidney transplant recipients (80 male/53 female; mean age of 39 ± 12 y) and 158 healthy volunteers (86 male/69 female; mean age of 40 ± 15 y). Groups were statistically matched in age, male/female patients, and body mass index. Fall index percentages were calculated using the Tetrax posturography device. Risk of falling was compared between kidney transplant recipients and healthy participants. Kidney transplant recipients were divided into 3 groups based on risk of falling. Demographic and clinical characteristics of kidney transplant recipients were recorded, and statistical analyses were performed to analyze these parameters versus balance measurements. RESULTS Risk of falling was not significantly different between groups according to Tetrax measurements (32.4 ± 23.4 vs 31.6 ± 21.7; P = .08). Serum creatinine levels were significantly higher in kidney transplant recipients with a higher risk of falling (1.17 ± 0.37 vs 1.63 ± 1.18 mg/dL; P = .01). The use of oral antidiabetic drugs was shown to increase the risk of falling (P = .02). CONCLUSIONS Although patients with end-stage renal disease are thought to have balance impairments, kidney transplant recipients in our study had balance control similar to that shown in the healthy population. Graft function in kidney transplant recipients is important for the balance system.
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Affiliation(s)
- Nihan Tekkarismaz
- From the Nephrology Department, Baskent University Adana Dr Turgut Noyan Research and Training Center, Adana, Turkey
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