Top

BMC Nephrology

Published in:

Open Access 01-12-2022 | Research

Dysfunction in dynamic, but not static balance is associated with risk of accidental falls in hemodialysis patients: a prospective cohort study

Authors: Nobuyuki Shirai, Suguru Yamamoto, Yutaka Osawa, Atsuhiro Tsubaki, Shinichiro Morishita, Ichiei Narita

Published in: BMC Nephrology | Issue 1/2022

Abstract

Background

Patients with chronic kidney disease undergoing hemodialysis (HD) have a high incidence of falls. Impairment of balance function is a risk factor for falls in the general elderly, and no report examining the association between balance dysfunction and fall incidence in HD patients exists.

Methods

This prospective cohort study was conducted at a single center. The timed-up-and-go test (TUG) as a dynamic balance function was performed and length of the center of pressure (CoP) as a static balance function was measured before and after the HD session at baseline. Data of the number and detailed information of accidental falls for 1 year were collected. Multiple regression analyses were performed to assess the relationships between the number of falls and balance function.

Results

Forty-three patients undergoing HD were enrolled in the study. During 1 year of observation, 24 (55.8%) patients experienced accidental falls. TUG time was longer, and CoP was shorter in the post-HD session than in the pre-HD session. Adjusted multiple regression analyses showed that the number of accidental falls was independently associated with TUG time in the pre-HD session (B 0.267, p < 0.001, R² 0.413) and that in the post-HD session (B 0.257, p < 0.001, R² 0.530), but not with CoP.

Conclusions

Dynamic balance was associated with fall incidence in maintenance HD patients. The evaluation and intervention of dynamic balance function might reduce the risk of falls in HD patients.

Trial registration

This study was carried out with the approval of the Niigata Rinko Hospital Ethics Committee (approval number 2005–92) (Registered on December 11, 2019) and registered in The University Hospital Medical Information Network (registration number 000040618).

Available only for authorised users

Goto NA, Weststrate ACG, Oosterlaan FM, Verhaar MC, Willems HC, Emmelot-Vonk MH, et al. The association between chronic kidney disease, falls, and fractures: a systematic review and meta-analysis. Osteoporos Int. 2020;31(1):13–29. https://doi.org/10.1007/s00198-019-05190-5.CrossRefPubMed

Kim SM, Long J, Montez-Rath M, Leonard M, Chertow GM. Hip fracture in patients with non-Dialysis-requiring chronic kidney disease. J Bone Miner Res. 2016;31(10):1803–9. https://doi.org/10.1002/jbmr.2862.CrossRefPubMed

Yeung SSY, Reijnierse EM, Pham VK, Trappenburg MC, Lim WK, Meskers CGM, et al. Sarcopenia and its association with falls and fractures in older adults: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2019;10(3):485–500. https://doi.org/10.1002/jcsm.12411.CrossRefPubMedPubMedCentral

Chou JA, Kalantar-Zadeh K. Volume balance and intradialytic ultrafiltration rate in the hemodialysis patient. Curr Heart Fail Rep. 2017;14(5):421–7. https://doi.org/10.1007/s11897-017-0356-6.CrossRefPubMedPubMedCentral

Bobowik P, Wiszomirska I, Leś A, Kaczmarczy KK. Selected tools for assessing the risk of falls in older women. Biomed Res Int. 2020;12:2065201. https://doi.org/10.1155/2020/2065201.CrossRef

Howcroft J, Lemaire ED, Kofman J, McIlroy WE. Elderly fall risk prediction using static posturography. PLoS One. 2017;12(2):e0172398. https://doi.org/10.1371/journal.pone.0172398.CrossRefPubMedPubMedCentral

Beauchet O, Fantino B, Allali G, Muir SW, Montero-Odasso M, Annweiler C. Timed up and go test and risk of falls in older adults: a systematic review. J Nutr Health Aging. 2011;15(10):933–8. https://doi.org/10.1007/s12603-011-0062-0.CrossRefPubMed

Corriveau H, Hébert R, Raîche M, Dubois MF, Prince F. Postural stability in the elderly: empirical confirmation of a theoretical model. Arch Gerontol Geriatr. 2004;39(2):163–77. https://doi.org/10.1016/j.archger.2004.03.001.CrossRefPubMed

Lamb SE, Jørstad-Stein EC, Hauer K, Becker C. Prevention of falls network Europe and outcomes consensus group. Development of a common outcome data set for fall injury prevention trials: the prevention of falls network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–22. https://doi.org/10.1111/j.1532-5415.2005.53455.x.CrossRefPubMed

10.

Cook WL, Tomlinson G, Donaldson M, Markowitz SN, Naglie G, Sobolev B, et al. Falls and fall-related injuries in older dialysis patients. Clin J Am Soc Nephrol. 2006;1(6):1197–204. https://doi.org/10.2215/CJN.01650506.CrossRefPubMed

11.

Dipietro L, Campbell WW, Buchner DM, Erickson KI, Powell KE, Bloodgood B, et al. Physical activity, injurious falls, and physical function in aging: An umbrella review. Med Sci Sports Exerc. 2019;51(6):1303–13.CrossRef

12.

Morishita S, Kaida K, Aoki O, Yamauchi S, Wakasugi T, Ikegame K, et al. Balance function in patients who had undergone allogeneic hematopoietic stem cell transplantation. Gait Posture. 2015;42(3):406–8. https://doi.org/10.1016/j.gaitpost.2015.07.011.CrossRefPubMed

13.

Abdel-Rahman EM, Yan G, Turgut F, Balogun RA. Long-term morbidity and mortality related to falls in hemodialysis patients: role of age and gender - a pilot study. Nephron Clin Pract. 2011;118(3):c278–84. https://doi.org/10.1159/000322275.CrossRefPubMed

14.

Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990;19(2):136–41. https://doi.org/10.1093/ageing/19.2.136.CrossRefPubMed

15.

Polinder-Bos HA, Emmelot-Vonk MH, Gansevoort RT, Diepenbroek A, Gaillard CA. High fall incidence and fracture rate in elderly dialysis patients. Neth J Med. 2014;72(10):509–15.PubMed

16.

Li M, Tomlinson G, Naglie G, Cook WL, Jassal SV. Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients. Nephrol Dial Transplant. 2008;23(4):1396–400. https://doi.org/10.1093/ndt/gfm778.CrossRefPubMed

17.

Medical Advisory Secretariat. Prevention of falls and fall-related injuries in community-dwelling seniors: an evidence-based analysis. Ont Health Technol Assess Ser. 2008;8(2):1–78.PubMedCentral

18.

Orwoll ES, Fino NF, Gill TM, Cauley JA, Strotmeyer ES, Ensrud KE, et al. The relationships between physical performance, activity levels, and falls in older men. J Gerontol A Biol Sci Med Sci. 2019;74(9):1475–83. https://doi.org/10.1093/gerona/gly248.CrossRefPubMed

19.

Gomes EP, Reboredo MM, Carvalho EV, Teixeira DR, Carvalho LF, Filho GF, et al. Physical activity in hemodialysis patients measured by Triaxial accelerometer. Biomed Res Int. 2015;2015:645645. https://doi.org/10.1155/2015/645645.CrossRefPubMedPubMedCentral

20.

Rogers ME, Page P, Takeshima N. Balance training for the older athlete. Int J Sports Phys Ther. 2013;8(4):517–30.PubMedPubMedCentral

21.

Ibrahim A, Singh DKA, Shahar S. 'Timed up and Go' test: age, gender and cognitive impairment stratified normative values of older adults. PLoS One. 2017;12(10):e0185641. https://doi.org/10.1371/journal.pone.0185641.CrossRefPubMedPubMedCentral

22.

Shirai N, Yamamoto S, Osawa Y, Tsubaki A, Morishita S, Igarashi K, et al. Comparison of muscle strength between hemodialysis patients and non-dialysis patients with chronic kidney disease. J Phys Ther Sci. 2021;33(10):742-747. https://doi.org/10.1589/jpts.33.742.

23.

Kim JC, Kalantar-Zadeh K, Kopple JD. Frailty and protein-energy wasting in elderly patients with end stage kidney disease. J Am Soc Nephrol. 2013;24(3):337–51. https://doi.org/10.1681/ASN.2012010047.CrossRefPubMed

24.

Sato E, Mori T, Mishima E, Suzuki A, Sugawara S, Kurasawa N, et al. Metabolic alterations by indoxyl sulfate in skeletal muscle induce uremic sarcopenia in chronic kidney disease. Sci Rep. 2016;6:36618. https://doi.org/10.1038/srep36618.CrossRefPubMedPubMedCentral

25.

Watanabe H, Miyamoto Y, Enoki Y, Ishima Y, Kadowaki D, Kotani S, et al. P-Cresyl sulfate, a uremic toxin, causes vascular endothelial and smooth muscle cell damages by inducing oxidative stress. Pharmacol Res Perspect. 2015;3(1):e00092. https://doi.org/10.1002/prp2.92.CrossRefPubMed

26.

Dzik KP, Kaczor JJ. Mechanisms of vitamin D on skeletal muscle function: oxidative stress, energy metabolism and anabolic state. Eur J Appl Physiol. 2019;119(4):825–39. https://doi.org/10.1007/s00421-019-04104-x.CrossRefPubMedPubMedCentral

27.

Zanotto T, Mercer TH, Linden MLV, Traynor JP, Doyle A, Chalmers K, et al. Association of postural balance and falls in adult patients receiving haemodialysis: a prospective cohort study. Gait Posture. 2020;82:110–7. https://doi.org/10.1016/j.gaitpost.2020.08.128.CrossRefPubMed

28.

Pijnappels M, van der Burg PJ, Reeves ND, van Dieën JH. Identification of elderly fallers by muscle strength measures. Eur J Appl Physiol. 2008;102(5):585–92. https://doi.org/10.1007/s00421-007-0613-6.CrossRefPubMed

29.

Lord SR. Visual risk factors for falls in older people. Age Ageing. 2006;35(Suppl 2):ii42–5. https://doi.org/10.1093/ageing/afl085.CrossRefPubMed

30.

Shaffer SW, Harrison AL. Aging of the somatosensory system: a translational perspective. Phys Ther. 2007;87(2):193–207. https://doi.org/10.2522/ptj.20060083.CrossRefPubMed

31.

Frih B, Mkacher W, Jaafar H, Frih A, Ben Salah Z, El May M, et al. Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis. Disabil Rehabil. 2018;40(7):784–90. https://doi.org/10.1080/09638288.2016.1276971.CrossRefPubMed

32.

Lee HG, An J, Lee BH. The effect of progressive dynamic balance training on physical function, the ability to balance and quality of life among elderly women who underwent a Total knee arthroplasty: a double-blind randomized control trial. Int J Environ Res Public Health. 2021;18(5):2513. https://doi.org/10.3390/ijerph18052513.CrossRefPubMedPubMedCentral

Title: Dysfunction in dynamic, but not static balance is associated with risk of accidental falls in hemodialysis patients: a prospective cohort study
Authors: Nobuyuki Shirai
Suguru Yamamoto
Yutaka Osawa
Atsuhiro Tsubaki
Shinichiro Morishita
Ichiei Narita
Publication date: 01-12-2022
Publisher: BioMed Central
Published in: BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-022-02877-6

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Dysfunction in dynamic, but not static balance is associated with risk of accidental falls in hemodialysis patients: a prospective cohort study

Abstract

Background

Methods

Results

Conclusions

Trial registration

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2022

Healthcare provider perspectives on integrating peer support in non-dialysis-dependent chronic kidney disease care: a mixed methods study

Biological variation in the serum and urine kidney injury markers of a healthy population measured within 24 hours

Association between uric acid level and contrast-induced acute kidney injury in patients with type 2 diabetes mellitus after coronary angiography: a retrospective cohort study

Association of serum klotho levels with different-staged vascular calcification status in patients with maintenance hemodialysis

To and TAFRO – a cryptic cause of acute renal failure: a case report

The company we keep. Using hemodialysis social network data to classify patients’ kidney transplant attitudes with machine learning algorithms

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page