The effect of hemodialysis session on postural strategies in older end‐stage renal disease patients

Abstract

Patients suffering from end-stage renal disease experience multiple disabilities, such as muscle wasting, weakness, higher postural sway, and fall rates compared with healthy population, which has a negative effect on physical functioning and autonomy. The vital treatment of hemodialysis is recognized to induce important post-hemodialysis fatigue, hypotension, cramps, and headache due to the rapid fluid redistribution, among others. Nevertheless, even the well-known negative effect of aforementioned consequences of hemodialysis treatment, its effect on physical function, especially postural balance, is unclear. Thus, this study hypothesized the adverse effect of hemodialysis treatment on postural sway in 12 end-stage renal disease patients (mean age 63.3 ± 11 years) through the analysis of center-of-pressure (COP) trajectories recorded before and immediately after hemodialysis session. Evident postural alterations were observed at post-hemodialysis balance assessment for COP position-based (Fs < 7.7, P < 0.02) and COP velocity-based variables (Fs > 2.33, P < 0.05), without changes in complexity of COP time series in anteroposterior and mediolateral directions. These results suggest that period after hemodialysis treatment is particularly unsafe, as evidenced by important disability in postural control, and highlight the importance of the medical support and falls-related prevention strategies of these older frail patients after hemodialysis treatment.

Combining intra‐dialytic exercise and nutritional supplementation in malnourished older haemodialysis patients: Towards better quality of life and autonomy

“…The GN patients have higher postural sway and therefore potentially higher risk of falls with consequent morbidity and disability. 18 Finally, the increase in both physical (+72%) and mental dimensions (+40%) of QoL observed in GN-Ex is consistent with Painter's study, 17 which demonstrated that the frailest patients experienced the greatest improvement in QoL following exercise. The QoL scores are highly predictive of hospitalizations and mortality 19 ; thus, the improvement obtained in GN-Ex patients is even more interesting, satisfactory, and fully positive, given the specific characteristics of the studied population.…”

“…The balance assessment reinforced this key point. The G N patients have higher postural sway and therefore potentially higher risk of falls with consequent morbidity and disability . Finally, the increase in both physical (+72%) and mental dimensions (+40%) of QoL observed in G N‐Ex is consistent with Painter's study, which demonstrated that the frailest patients experienced the greatest improvement in QoL following exercise.…”

Hemodynamic response to orthostatic stress immediately after dialysis session in chronic hemodialysis patients

“…Furthermore, a greater postural sway in the post-versus pre-HD session was observed [18] in addition to poorer postural control in HD patients than in age-matched controls, which was further exacerbated by the simultaneous performance of a cognitive task [19]. These results suggest that the immediate post-HD period is particularly unsafe, so medical staff in dialysis units should be sure to provide the necessary support [18]. Accordingly, dialysis staff should consider such alterations concerning physical function post-dialysis as well as the probability of the aforementioned postural hypotension immediately after the HD session.…”

“…Soangra et al reported decreased sit-to-walk test performance pre-versus post-HD session [17]. Furthermore, a greater postural sway in the post-versus pre-HD session was observed [18] in addition to poorer postural control in HD patients than in age-matched controls, which was further exacerbated by the simultaneous performance of a cognitive task [19]. These results suggest that the immediate post-HD period is particularly unsafe, so medical staff in dialysis units should be sure to provide the necessary support [18].…”

Dialytic hemodynamics are associated with changes in gait speed

“…In a small study of twelve patients it was noted that an HD session had a negative impact on postural balance, however there was no evaluation of an HD specific risk factor for the worsening balance. 22 Our study evaluated the relationship with intra-dialytic hemodynamics (an HD specific risk factor) and changes in mobility post HD. Our results suggest that greater drop in BP during dialysis, even in the absence of absolute hypotension (SBP < 100), can lead to impairment in gait speed adds important information on HD specific risk factors for functional impairment post HD.…”