Incidência e fatores associados às quedas em pacientes com doença renal crônica em diálise: um estudo prospectivo de 12 meses

Abstract

Patients on hemodialysis have complications due chronic kidney disease and its treatment that can increase the risk of falls. Then, the main aim of this study was to identify the incidence of falls and factors associated with risk and number of falls in patients on hemodialysis, and the specific aims were to assess the factors associated with postural balance and to investigate the measurement properties of Falls Efficacy Scale (FES). METHODS: A 12-month prospective study was conducted with patients in regular hemodialysis. They were assessed by physical function (gait speed over 15-feet, timed up and goTUG, 5-repetition sit-to-stand test-5-STS, and handgrip strength), postural balance (Mini Balance Evaluation Systems Test-Mini-BESTest and posturography), frailty (modified Fried frailty phenotype), fear of falling (Falls Efficacy Scale-International-FES-I and FES), and quality of life (36-Item Short Form Health Survey-SF-36). After this initial assessment, monthly interviews were conducted for 12 months for monitoring of falls. RESULTS: Of the 112 patients included (58.7±12.9 years, 56.3% male), 31.3% were classified as fallers. The incidence rate was 1.62 (95%CI:1.03-2.22) falls/person-year. The 5- STS (seconds; OR:1.10; 95%CI:1.02-1.19) and frailty (OR:4.78; 95%CI:1.22- 18.81) were associated with the occurrence of falls. The gait speed (meters/second; OR:0.25; 95%CI:0.07-0.87), TUG (seconds; OR:1.38; 95%CI:1.17-1.62), handgrip strength (kilogram force; OR:0.94; 95%CI:0.90- 0.98), Mini-BESTest (score; OR:0.84; 95%CI:0.77-0.93), frailty (OR:3.99; 95%CI:1.67-9.49), FES-I (score; OR:1.11; 95%CI:1.06-1.17), and four domains of SF-36: physical functioning (score; OR:0.98; 95%CI:0.96-0.99), physical role (score; OR:0.99; 95%CI:0.98-0.99), vitality (score; OR:0.98; 95%CI:0.97-0.99), and mental health (score; OR:0.98; 95%CI:0.96-0.99) were associated with the number of falls. The presence of diabetes mellitus (B:5.33; CI95%:0.30 to 10.37) and neurological disease (B:8.18; CI95%:1.34 to 15.02) and gait speed (B:-14.10; CI95%:-23.58 to -4.62) were associated with the center of pressure (CP) path length in the eyes opened test (R²=0.26; p<0.001). The presence of neurological disease (B:19.55; CI95%:7.47 to 31.62; R²=0.18; p=0.002) was associated with the CP path length in the eyes closed test. The presence of diabetes mellitus (B:18.00; CI95%:5.95 to 30.05; R²=0.22; p<0.001) was associated with the CP path length in the eyes opened on a foam surface test. In the investigation of measurement properties of FES, the interrater and intrarater intraclass correlation coefficient were, respectively, 0.91 and 0.78. The standard error of measurement for inter and intrarater assessments were 2.99 and 4.46, and the minimal detectable change were 9.26 and 12.33, respectively. The interrater mean difference score was 0.26 (95% limits of agreement: -8.01 to 8.53), and the intrarater mean difference score was -1.06 (95% limits of agreement: -13.39 to 11.27). CONCLUSION: Physical function, postural balance, frailty, fear of falling, and quality of life were associated with falls. The presence of diabetes mellitus and neurological disease and a slower gait speed were associated with poor postural balance. FES presented adequate measurement properties.