Kono Kenichi, Nishida Yusuke, Yabe Hiroki, Moriyama Yoshihumi, Mori Toshihiko, Shiraki Ryota, Sato Takashi
School of Health Science at Narita Department of Physical Therapy, International University of Health and Welfare, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan.
School of Rehabilitation Department of Physical Therapy, Seirei Christopher University, Hamamatsu, Shizuoka, Japan.
Clin Exp Nephrol. 2018 Feb;22(1):167-172. doi: 10.1007/s10157-017-1431-8. Epub 2017 Jun 20.
Dialysis patients often have low physical performance due to uremic sarcopenia, protein energy wasting (PEW), and incidence intradialytic hypotension (IDH), which are indicated as risk factors for falling. The objective of this study was to develop a symptom-encompassing evaluation form to predict falls with high sensitivity for dialysis patients.
A total of 251 patients who had been receiving maintenance hemodialysis therapy three times a week were enrolled in the study. Demographics, malnutrition and inflammatory status, dialytic therapeutic management situation, physical function and performance, and inquiries about falling were recorded. The Cox proportional hazards analysis evaluated the impact of falls. Calculated hazard ratios were converted to weighted scores, using approximate multiples of 0.5 and an evaluation form was created, which we called the Dialysis Fall Risk Index (DFRI). Kaplan-Meier survival analyses with the log-rank test and the Cox proportional hazard analysis were performed to evaluate the validity of the DFRI.
The DFRI consisted of seven items and a total of 12 points. The predictive validity of DFRI included hazard ratios for quartile 3 and 4 of 2.65 and 3.84, respectively, compared with quartile 1 as a reference point. The cut-off point of the DFRI showed the highest sensitivity and specificity among other screening indices.
The present study included the development of a new evaluation form that encompasses symptoms of end-stage kidney disease to predict falls in dialysis patients.
由于尿毒症性肌肉减少症、蛋白质能量消耗（PEW）和透析中低血压（IDH）的发生率，透析患者的身体机能往往较低，这些因素被视为跌倒的危险因素。本研究的目的是开发一种涵盖症状的评估表，以高灵敏度预测透析患者的跌倒情况。
共有251名每周接受三次维持性血液透析治疗的患者纳入本研究。记录了人口统计学信息、营养不良和炎症状态、透析治疗管理情况、身体功能和表现以及跌倒询问情况。Cox比例风险分析评估了跌倒的影响。将计算出的风险比转换为加权分数，使用近似0.5的倍数，并创建了一个评估表，我们称之为透析跌倒风险指数（DFRI）。进行了Kaplan-Meier生存分析及对数秩检验和Cox比例风险分析，以评估DFRI的有效性。
DFRI由七个项目组成，共12分。与作为参考点的第一四分位数相比，DFRI的预测有效性包括第三和第四四分位数的风险比分别为2.65和3.84。DFRI的截断点在其他筛查指标中显示出最高的灵敏度和特异性。
本研究包括开发一种新的评估表，该表涵盖终末期肾病的症状，以预测透析患者的跌倒情况。
