Pérez-Gurbindo Ignacio, Angulo Carrere María Teresa, Arribas Cobo Patricia, Puerta Marta, Ortega Mayra, Jaldo Maria Teresa, de Sequera Patricia, Alcázar Roberto, Pérez-García Rafael, Álvarez-Méndez Ana María
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutenese de Madrid, Madrid, España.
Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutenese de Madrid, Madrid, España.
Nefrologia (Engl Ed). 2020 Nov-Dec;40(6):655-663. doi: 10.1016/j.nefro.2020.04.014. Epub 2020 Jul 7.
Postural balance is the result of a complex interaction of sensory input which keeps us upright. Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Our objective was to analyse postural stability and its relationship with the risk of falls in haemodialysis patients using a force platform.
This was a prospective cross-sectional study. Postural balance was recorded using a force platform in prevalent haemodialysis patients. We collected epidemiological, dialysis, analytical and treatment data. The incidence of falls was recorded over the 6 months following the tests. The postural stability analysis was performed with a portable strain gauge platform (AMTI AccuGait®) and a specific software unit for stabilometry (Balance Trainer® program). We measured 31 balance parameters; the balance variables used were: Area95; AreaEffect; VyMax; Xrange and Yrange. The stabilometry studies were performed in 3 situations: with eyes open; with eyes closed; and with the patient performing a simultaneous task. We performed one study at the start of the dialysis session, and a second study at the end. Stabilometry was measured in a control group under similar conditions.
We studied 32 patients with a mean age of 68 years old; of this group, 20 subjects were male and 12 were female. Their mean weight was 74kg, with a mean BMI of 27.6kg/m. In the controls, there were no significant differences in the stabilometry between the 3 situations studied. Both pre- and post-haemodialysis, patients with closed eyes showed greater imbalance, and there were significant differences with the other situations and controls. We found a significant increase in instability after the haemodialysis session, and greater instability in the 13 patients with diabetes (P<.05). The 4 patients with hyponatraemia (Na<136mmol/l) had worse balance in the simultaneous task situation (P=.038). Various drugs, such as insulin (P=.022), antiplatelet agents (P=.036) and beta-blockers (P=.029), were associated with imbalance. The 10 patients who suffered falls had greater imbalance, Yrange, Xrange, Area95 and AreaEffect, both pre- and post-haemodialysis (P<.05) than those without falls.
Haemodialysis patients have alterations which can lead to postural instability and a risk of falls. Prevention programmes which include specific exercises to improve balance could be beneficial in reducing the risk of falls in this population.
姿势平衡是感觉输入复杂相互作用的结果，它使我们保持直立。血液透析患者存在一些改变，可能导致姿势不稳定和跌倒风险。我们的目的是使用测力平台分析血液透析患者的姿势稳定性及其与跌倒风险的关系。
这是一项前瞻性横断面研究。使用测力平台记录维持性血液透析患者的姿势平衡。我们收集了流行病学、透析、分析和治疗数据。在测试后的6个月内记录跌倒发生率。姿势稳定性分析使用便携式应变仪平台（AMTI AccuGait®）和用于稳定测量的特定软件单元（Balance Trainer®程序）进行。我们测量了31个平衡参数；使用的平衡变量为：Area95；AreaEffect；VyMax；Xrange和Yrange。稳定测量研究在3种情况下进行：睁眼；闭眼；以及患者执行同步任务时。我们在透析 session 开始时进行了一项研究，在结束时进行了第二项研究。在相似条件下对对照组进行稳定测量。
我们研究了32例平均年龄为68岁的患者；该组中，20例为男性，12例为女性。他们的平均体重为74kg，平均BMI为27.6kg/m²。在对照组中，所研究的3种情况下的稳定测量无显著差异。血液透析前后，闭眼患者均表现出更大的不平衡，与其他情况和对照组相比存在显著差异。我们发现血液透析 session 后不稳定性显著增加，13例糖尿病患者的不稳定性更高（P<.05）。4例低钠血症（Na<136mmol/l）患者在同步任务情况下平衡更差（P=.038）。各种药物，如胰岛素（P=.022）、抗血小板药物（P=.036）和β受体阻滞剂（P=.029）与不平衡有关。10例跌倒患者在血液透析前后的不平衡、Yrange、Xrange、Area95和AreaEffect均比未跌倒患者更大（P<.05）。
血液透析患者存在一些改变，可能导致姿势不稳定和跌倒风险。包括特定锻炼以改善平衡的预防计划可能有助于降低该人群的跌倒风险。
