Background

Static postural balance performance is often impaired in people receiving haemodialysis (HD) for the treatment of stage-5 chronic kidney disease (CKD-5). However, the question as to whether lower postural balance is associated with adverse clinical outcomes such as falls has not been addressed yet.

Research question

We conducted a prospective cohort study to explore the association between static postural balance and falls in people receiving HD. We hypothesised that higher postural sway would be associated with increased odds of falling.

Methods

Seventy-five prevalent CKD-5 patients receiving HD (age: 61.8 ± 13.4 years) from three Renal Units were enrolled in this prospective cohort study. At baseline, postural balance was assessed with a force platform in eyes open (EO) and eyes closed (EC) conditions. Centre of pressure (CoP) measures of range, velocity and area were taken for the analysis. Falls experienced by study participants were prospectively recorded during 12 months of follow-up. Secondary outcomes included timed-up and go, five-repetition sit-to-stand test and the Tinetti falls efficacy scale (FES).

Results

In multivariable logistic regression analysis, higher CoP range in medial-lateral direction during EC was associated with increased odds of falling (OR: 1.04, 95 %CI: 1.00−1.07, p = 0.036). In ROC curve analysis, CoP velocity in EO exhibited the greatest prognostic accuracy (AUC: 0.69, 95 %CI: 0.55−0.82), however this was not statistically different from CoP measures of area and range. None of the postural balance measures exceeded the prognostic accuracy of the FES (AUC: 0.70, 95 %CI: 0.58−0.83, p = 0.005).

Significance

This prospective cohort study showed that higher postural sway in medial-lateral direction was associated with increased odds of falling in people receiving HD. CoP measures of range, velocity and area displayed similar prognostic value in discriminating fallers from non-fallers. The overall utility of static posturography to detect future fall-risk may be limited in a clinical setting.

中文翻译：

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成年患者接受血液透析的姿势平衡与跌倒的关联：一项前瞻性队列研究。

背景

在接受血液透析（HD）治疗5期慢性肾脏病（CKD-5）的人群中，静态姿势平衡性能经常受到损害。但是，关于姿势平衡降低是否与诸如跌倒之类的不良临床结果有关的问题尚未得到解决。

研究问题

我们进行了一项前瞻性队列研究，以探讨静态姿势平衡与接受HD的人跌倒之间的关系。我们假设较高的姿势摇摆会导致摔倒的几率增加。

方法

这项前瞻性队列研究纳入了来自三个肾单位接受HD（年龄：61.8±13.4岁）的75例CKD-5流行患者。基线时，在睁眼（EO）和闭眼（EC）的情况下使用力平台评估姿势平衡。分析了压力中心（CoP）的范围，速度和面积。在随访的12个月中前瞻性地记录了研究参与者经历的跌倒。次要结果包括定时走位，五次重复坐立测验和Tinetti跌倒疗效量表（FES）。

结果

在多变量logistic回归分析中，EC期间内外侧CoP范围较高与跌倒几率增加相关（OR：1.04，95％CI：1.00-1.07，p = 0.036）。在ROC曲线分析中，EO中的CoP速度表现出最大的预后准确性（AUC：0.69，95％CI：0.55-0.82），但这与CoP测量面积和范围没有统计学差异。姿势平衡措施均未超过FES的预后准确性（AUC：0.70，95％CI：0.58-0.83，p = 0.005）。

意义

这项前瞻性队列研究显示，在内侧-外侧方向上较高的姿势摇摆与接受HD的人跌倒的几率增加相关。区分范围，速度和面积的CoP指标在区分跌倒者和非跌倒者中显示出相似的预后价值。在临床环境中，静态姿势描记法检测未来跌倒风险的整体用途可能受到限制。