Abstract
BackgroundStage 5 chronic kidney disease patients on haemodialysis (HD) often present with dizziness and pre-syncopal events as a result of the combined effect of HD therapy and cardiovascular disease. The dysregulation of blood pressure (BP) during orthostasis may be implicated in the aetiology of falls in these patients. Therefore, we explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients.MethodsSeventy-six HD patients were enrolled in this cross-sectional study. Participants were classified as “fallers” and “non-fallers” and completed a passive head up tilting to 60o (HUT-60°) test on an automated tilt table. ECG signals, continuous and oscillometric BP measurements and impedance cardiography were recorded. The following variables were derived from these measurements: heart rate (HR) stroke volume (SV), cardiac output (CO), total peripheral resistance (TPR), number of baroreceptor events, and baroreceptor effectiveness index (BEI).ResultsThe forty-four participants who were classified as fallers (57.9%) had a lower number of baroreceptor events (6.5±8.5 vs 14±16.7, p = .027) and BEI (20.8±24.2% vs 33.4±23.3%, p = .025). In addition, fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric BP from supine to HUT-60° compared with non-fallers. None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis.ConclusionsThis cross-sectional comparison indicates that, at rest, HD patients with a positive history of falls present with a lower count of baroreceptor sequences and BEI.Short-term BP regulation warrants further investigation as BP drops during a passive orthostatic challenge may be implicated in the aetiology of falls in HD.
Highlights
The World Health Organization (WHO) global report on falls prevention in older age [1] states that approximately 30% of people aged 65 years and older experience at least one fall every year, and nearly 50% of all injury-related hospital admissions are attributed to falls
Fallers experienced a significantly larger drop in systolic (-6.4±10.9 vs -0.4±7.7 mmHg, p = .011) and diastolic (-2.7±7.3 vs 1.8±6 mmHg, p = .027) oscillometric blood pressure (BP) from supine to head-up tilt at 60 ̊ (HUT-60) ̊ compared with non-fallers
None of the variables taken for the analysis were significantly associated with falls in multivariate logistic regression analysis
Summary
The World Health Organization (WHO) global report on falls prevention in older age [1] states that approximately 30% of people aged 65 years and older experience at least one fall every year, and nearly 50% of all injury-related hospital admissions are attributed to falls. Stage 5 chronic kidney disease (CKD-5) patients undergoing haemodialysis (HD) therapy have been reported to have a higher risk of falling than the general population [2]. Prospective cohort studies of HD patients, with a 12-month follow-up, report that 26.3% [3] to 47% [4] experience at least one fall per annum. A few prospective cohort studies have explored the association of potential clinical risk factors and falls in CKD-5 patients undergoing HD therapy with physical frailty primarily, older age, comorbidity, previous history of falls, and polypharmacy [2,3,4, 6] appearing to play a central role in the aetiology of falling. We explored the relationship between baroreflex function, the haemodynamic responses to a passive orthostatic challenge, and falls in HD patients
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