title: The effect of hemodialysis on balance measurements and risk of fall.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) have increased risk of falls and fall-related complications. Other than aging and factors related to chronic kidney disease, treatment of hemodialysis may also contribute to this increased risk. The aim of this study was to demonstrate the impairment of balance after a session of hemodialysis with a quantitative assessment and reveal an increased fall risk that would possibly be related to treatment of hemodialysis for patients on maintenance hemodialysis.
  
  
  METHODS
  Fifty-six patients with ESRD on chronic hemodialysis program and 53 healthy individuals were involved in this study. Fall Index percentages were calculated, and fall risk categories were determined for all patients and healthy controls using Tetrax posturography device (Sunlight Medical Ltd Israel). The patient group was evaluated twice for balance, before and after a routine session of hemodialysis.
  
  
  RESULTS
  Fall Index scores of healthy controls were lower than that of ESRD patients (p = 0.001). In the patient group, we found the mean Fall Index to be significantly higher at the post-dialysis assessment compared to the pre-dialysis assessment (p = 0.003). The number of patients with high risk of falling also increased at the post-dialysis assessment yet the difference did not reach significance. Fall Index was correlated with the increase in age only at the pre-dialysis balance measurement (p = 0.038). Patients with better dialysis adequacy had significantly lower Fall Index scores than the others at the pre-dialysis balance measurement (p = 0.004). The difference was not significant at the post-dialysis measurement.
  
  
  CONCLUSIONS
  In the current study, we evaluated the balance of ESRD patients before and after a routine session of hemodialysis treatment. This is the first study to investigate the effect of hemodialysis on balance, using an electronic posturographic balance system. We found the Fall Index score to be significantly higher after hemodialysis, indicating a negative effect of hemodialysis on postural stability. As expected, our data showed an increased Fall Index score correlated with the increase in age both in ESRD patients and in healthy controls. However, the correlation with age was not observed for the patient group at the post-dialysis balance measurement. We might conceive that young patients with ESRD are also prone to fall risk after a session of hemodialysis. Methods that provide quantitative assessment for fall risk could be rather beneficial for high-risk populations such as patients on maintenance hemodialysis.
authors: Department of Nephrology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey. ertugrulerken@hotmail.com.
authors: Ertugrul
authors: http://orcid.org/0000-0002-7054-1203
authors: E
authors: Erken
authors: Department of Nephrology, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey.
authors: Ruya
authors: R
authors: Ozelsancak
authors: Department of Internal Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
authors: Safak
authors: S
authors: Sahin
authors: Department of Physical Therapy and Rehabilitation, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey.
authors: Emine Ece
authors: EE
authors: Yılmaz
authors: Department of Nephrology, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey.
authors: Dilek
authors: D
authors: Torun
authors: Department of Physical Therapy and Rehabilitation, Adana Research and Training Hospital, Faculty of Medicine, Baskent University, Adana, Turkey.
authors: Berrin
authors: B
authors: Leblebici
authors: Department of Biostatistics, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
authors: Yunus Emre
authors: YE
authors: Kuyucu
authors: Department of Nephrology, Faculty of Medicine, Baskent University, Ankara, Turkey.
authors: Siren
authors: S
authors: Sezer
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment / Q000379:methods
keywords: Balance; End-stage renal disease; Fall risk; Hemodialysis; Postural stability