Abstract
Objective:to identify possible associations between a higher probability of falls among hemodialysis patients and laboratory values, comorbidities, pharmacological treatment, hemodynamic changes, dialysis results and stabilometric alterations.Method:this was a retrospective case-control study with hemodialysis patients. Patients in a hemodialysis unit who had suffered one or more falls were included in the case group. Patients from the same unit who had not suffered falls were the controls. Data were gathered from the patients’ clinical history and also from the results of a balance test conducted six months before the study.Results:thirty-one patients were included (10 cases and 21 controls). Intradialytic body weight change was significantly greater among cases (p <0.05). Patients in the case group also presented greater lateral instability after dialysis (p <0.05). Other factors such as high blood pressure, antihypertensives, beta-blockers, and lower heart rates were also associated with falls.Conclusion:a greater intradialytic weight change was associated with an increase in risk of falls. Nursing staff can control these factors to prevent the incidence of falls in dialysis patients.
Highlights
Moderate to severe Chronic Kidney Disease (CKD) affects 6.8%-9.5% of the population[1] and involves the accumulation of waste substances such as uremic toxins, which cannot be eliminated due to impaired renal function
The excess liquid that must be extracted from patients varies depending on the weight gain that they experience in the interdialytic period and the difference between their calculated optimum weight or dry weight, which is defined as weight when there is no fluid excess or deficiency, without the presence of detectable peripheral edemas, with normal blood pressure, and with no postural hypotension
Participants in the case group were 10 times less likely to be hypertensive than the control group (OR= 0.105, 95%confidence intervals (CI)=0.02-0.71)
Summary
Moderate to severe Chronic Kidney Disease (CKD) (stages 3-5) affects 6.8%-9.5% of the population[1] and involves the accumulation of waste substances such as uremic toxins, which cannot be eliminated due to impaired renal function. In Latin America the prevalence of patients treated with hemodialysis (HD) is 451 per million inhabitants[2] In these circumstances, patients must undergo dialysis several times a week, with the aim of eliminating uremic toxins and excess fluids, as well as rebalancing the concentrations of ions and other substances, which affect the body’s homeostasis. Patients must undergo dialysis several times a week, with the aim of eliminating uremic toxins and excess fluids, as well as rebalancing the concentrations of ions and other substances, which affect the body’s homeostasis These biochemical alterations affect the functioning of organs and systems related to balance; hyponatremia, which affects 6%-29% of patients receiving HD[3], has been associated with an increased risk of falls. The higher the weight gain, the higher the ultrafiltration rate required, resulting in an increased risk of hypotension during dialysis or postHD orthostatic hypotension[4,5], both situations associated with greater morbidity and mortality in patients receiving HD[6,7]
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