Abstract
BackgroundStage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls. Previous research has shown that frailty is one of the primary contributors to the increased risk of falling in this clinical population. However, HD patients often present with abnormalities of cardiovascular function such as baroreflex impairment and orthostatic dysregulation of blood pressure (BP) which may also be implicated in the aetiology of falling. Therefore, we aimed to explore the relative importance of frailty and cardiovascular function as potential exercise-modifiable predictors of falls in these patients.MethodsNinety-three prevalent CKD-5 patients on HD from three Renal Units were recruited for this prospective cohort study, which was conducted between October 2015 and August 2018. At baseline, frailty status was assessed using the Fried’s frailty phenotype, while physical function was evaluated through timed up and go (TUG), five repetitions chair sit-to-stand (CSTS-5), objectively measured physical activity, and maximal voluntary isometric strength. Baroreflex and haemodynamic function at rest and in response to a 60° head-up tilt test (HUT-60°) were also assessed by means of the Task Force Monitor. The number of falls experienced was recorded once a month during 12 months of follow-up.ResultsIn univariate negative binomial regression analysis, frailty (RR: 4.10, 95%CI: 1.60–10.51, p = 0.003) and other physical function determinants were associated with a higher number of falls. In multivariate analysis however, only worse baroreflex function (RR: 0.96, 95%CI: 0.94–0.99, p = 0.004), and orthostatic decrements of BP to HUT-60° (RR: 0.93, 95%CI: 0.87–0.99, p = 0.033) remained significantly associated with a greater number of falls. Eighty falls were recorded during the study period and the majority of them (41.3%) were precipitated by dizziness symptoms, as reported by participants.ConclusionsThis prospective study indicates that cardiovascular mechanisms implicated in the short-term regulation of BP showed a greater relative importance than frailty in predicting falls in CKD-5 patients on HD. A high number of falls appeared to be mediated by a degree of cardiovascular dysregulation, as evidenced by the predominance of self-reported dizziness symptoms.Trial registrationClinicalTrials.gov (trial registration ID: NCT02392299; date of registration: March 18, 2015).
Highlights
Stage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls
Zanotto et al BMC Nephrology (2020) 21:99 (Continued from previous page). This prospective study indicates that cardiovascular mechanisms implicated in the short-term regulation of blood pressure (BP) showed a greater relative importance than frailty in predicting falls in CKD-5 patients on HD
Previous research has shown that factors such as older age, comorbidity, polypharmacy and frailty seem to be principal factors implicated in the aetiology of falls in these patients [1, 2, 4, 7]
Summary
Stage 5 chronic kidney disease (CKD-5) patients on haemodialysis (HD) are at high risk of accidental falls. A few studies have begun to better explore the link between clinical outcomes such as falls and cardiovascular dysregulation in this patient group [5, 17, 18] It appears that the CKD-5 population on dialysis may be at risk of hypotension that can lead to postural dizziness, and potentially falls. We recently postulated that a drop in BP in response to a passive orthostatic challenge, as well as impaired baroreflex function may be linked to an increased risk of falling in HD patients [18] All of these observations seem to indirectly suggest that impaired BP control, to maintain haemodynamic stability, might be implicated as an additional factor in the aetiology of falls in the CKD-5 population on dialysis, due to the CKD-related autonomic failure and/or the dialysis-related hypotension. From a rehabilitation/therapeutic perspective, this could have important translational impact, since the short-term regulation of BP, as assessed by means of baroreflex function, has been shown to improve following active interventions such as exercise [20]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
