Abstract
BackgroundImpaired 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.MethodsThis 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.ResultsOf 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.ConclusionsMore 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.
Highlights
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)
To decreased muscle strength, uremic polyneuropathy, autonomic dysfunction, hypotensive episodes, and polypharmacy contribute to an increased risk of falls as well, resulting in a 4.4 times higher risk for hip fractures in HD patients compared to age-matched healthy control subjects [6, 7]
Participants and study design Patients on maintenance HD, who were included in a larger study, in two main dialysis centres were screened for eligibility between December 2016 and March 2018
Summary
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). Exercise intolerance, defined as decreased physical ability to perform activities requiring muscle strength and cardiovascular capacity, is common in patients on haemodialysis (HD) [1]. A reduced exercise capacity and muscle strength affects the ability to perform activities of daily living (ADL) [9], and potentially, the overall HealthRelated Quality of Life (HRQoL) [8, 10]. The impact of the risk of falls on HRQoL on top of muscle weakness and exercise capacity has not yet been examined in HD patients This is an important question as it could result in different training and rehabilitation needs for this population [8]
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