Abstract
O objetivo deste estudo foi avaliar a capacidade da Escala Internacional de Eficácia de quedas (FES-I), dos níveis séricos de paratormônio (PTH) e do tempo de tratamento hemodialítico (TTH) de discriminar pacientes com doença renal crônica (DRC) em tratamento hemodialítico caidores de não caidores. Foi realizado estudo transversal com 64 pacientes, com idade média de 44,2±14,8 anos. Foram coletados dados antropométricos, níveis séricos de PTH, histórico e risco de quedas (Escala Internacional de Eficácia de Quedas - FES-I), TTH e o nível de atividade física (Questionário Internacional de Atividade Física - IPAQ). Foram encontrados níveis séricos de PTH elevados em 64,1% dos pacientes, e 17,2% deles relataram histórico de queda no último ano. O tempo médio de TTH foi 50,3±37,5 meses. Nível de atividade física leve foi encontrado em 64,1%. Foi encontrada correlação positiva entre o PTH e o TTH (r=0,47; p<0,001). Não foram encontradas correlação entre o FES-I e o PTH (p<0,131), entre o FES-I e o TTH (p<0,153) nem entre o PTH (valor baixo/normal <450 pg/mL e valor elevado >450 pg/mL) e o risco de queda (caidores e não caidores) (p<0,158). No estudo, o instrumento FES-I mostrou-se capaz de discriminar hemodialíticos caidores de não caidores. Concluímos que a FES-I apresentou bom desempenho de avaliação entre caidores e não caidores, no entanto não foi observada associação entre caidores com os níveis séricos do PTH e com o TTH.
Highlights
The progressive and irreversible loss of kidney functioning[1,2] incurred by chronic kidney disease (CKD) has led to an increase in the incidence and prevalence of patients maintained in dialysis programs, and it has become a global public health issue[3]
The metabolic disturbance consequential of CKD associated with dialysis may reverberate in the musculoskeletal system through alterations in parathyroid hormones (PTH), calcium, phosphorus, and calcitriol, which occur precociously from stage 3 CKD onwards[1,4]
Recognizing the importance of evaluating the fear of falling in patients with CKD, this study aimed at assessing the capacity of the Falls Efficacy Scale International (FES-I), the serum levels of PTH, and the length of time on hemodialysis treatment (LTH) in discerning falling from non-falling patients with CKD under hemodialysis treatment. the assessment of the fear of falling is complex and involves physical, behavioral, and functional influences, the FES-I
Summary
The metabolic disturbance consequential of CKD associated with dialysis may reverberate in the musculoskeletal system through alterations in parathyroid hormones (PTH), calcium, phosphorus, and calcitriol, which occur precociously from stage 3 CKD onwards[1,4]. These alterations have a fundamental role in the physiopathology of bone diseases[5], and are directly related to morbimortality[6]. The low levels of calcitriol associated with high levels of PTH are related to myopathy, loss of balance, the occurrence and medical history of falls[10,11,12], and due to the latter, the decline of physical functioning[13]. Recognizing the importance of evaluating the fear of falling in patients with CKD, this study aimed at assessing the capacity of the FES-I, the serum levels of PTH, and the length of time on hemodialysis treatment (LTH) in discerning falling from non-falling patients with CKD under hemodialysis treatment. the assessment of the fear of falling is complex and involves physical, behavioral, and functional influences, the FES-I is an instrument whose total score is better associated with the medical history of falls in the last year[14]
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