Turkiye Klinikleri Journal of Health Sciences

.: REVIEW
Falls in Kidney Transplant Recipients: Traditional Review
Böbrek Nakli Alıcılarında Düşme: Geleneksel Derleme
Hatice Nihan BOZKURTa, Meriç YILDIRIMb
aDepartment of Physical Therapy and Rehabilitation, Dokuz Eylül University Institute of Health Sciences, İzmir, Türkiye
bDepartment of Cardiopulmonary Physiotheraphy and Rehabilitation, Dokuz Eylül University Faculty of Physical Therapy and Rehabilitation, İzmir, Türkiye
Turkiye Klinikleri J Health Sci. 2023;8(2):362-8
doi: 10.5336/healthsci.2022-94831
Article Language: EN
Full Text
ABSTRACT
 Kidney transplantation is the gold standard treatment for end stage renal disease. Despite the improvement in survival and quality of life, the prevalence of falls is higher in kidney transplant recipients. Factors that increase the risk for falls include female gender, older age, impaired balance control, lower ankle dorsiflexion muscle strength, high serum creatinine levels, and the use of antidiabetic medications. Functional limitations, fatigue, low cardio-respiratory fitness, changes in mineral metabolism lead to bone mineral disease in chronic kidney disease and can finally play an important role in occurrence of accidental falls in pre-transplantation period. Fractures without dislocations or head injury-related hemorrhages constitute a majority for the serious fall-related injury types. In addition to many factors such as cumulative dose of corticosteroids, younger age at transplantation, hyperparathyroidism, vitamin D deficiency and renal osteodystrophy, risk of falls also contribute to increased post-transplantation bone loss and fracture risk. Hip fractures requiring hospitalization in the post-kidney transplant period are associated with a higher risk of mortality. It is important to understand the underlying mechanisms for falls in kidney transplant recipients in order to prevent severe injuries including fractures and decrease healthcare costs. The awareness of healthcare professionals should be increased for falls in this specific population to design multidisciplinary therapeutic approaches including risk factor assessment, exercise programs and patient and caregiver education not only for kidney transplant recipients but also for the patients waiting on a transplantation list.

Keywords: Balance control; falls; kidney transplantation
ÖZET
 Böbrek nakli, son dönem böbrek yetersizliğinin tedavisinde altın standarttır. Yaşam kalitesi ve sağkalımdaki gelişmelere rağmen böbrek nakli alıcılarında düşme prevalansı yüksektir. Kadın cinsiyet, ileri yaş, bozulmuş denge kontrolü, azalmış ayak bileği dorsifleksör kas kuvveti, yüksek serum kreatinin düzeyi ve antidiyabetik ilaç kullanımı düşme riskini artıran faktörler arasında yer almaktadır. Fonksiyonel limitasyon, yorgunluk, düşük kardiyo-respiratuar uygunluk, mineral metabolizmasındaki değişiklikler kronik böbrek yetersizliğinde kemik mineral hastalığına yol açmaktadır ve sonuçta nakil öncesi dönemde kazara düşmelerin oluşmasında önemli bir rol oynamaktadır. Dislokasyon olmaksızın görülen kırıklar veya kafa travmasına bağlı görülen hemorajiler düşmeyle ilişkili ciddi yaralanmaların büyük bir kısmını oluşturmaktadır. Kümülatif kortikosteroid dozu, erken yaşta nakil olmak, hiperparatiroidizm, D vitamini eksikliği ve renal osteodistrofi gibi birçok faktöre ek olarak düşme riski de böbrek nakli sonrası kemik kaybı ve kırık riskinin artmasına neden olmaktadır. Böbrek nakli sonrası dönemde, hastane yatışı gerektiren kalça kırıkları yüksek mortalite riskiyle ilişkilidir. Böbrek nakli alıcılarında kırıkları içeren ciddi yaralanmaları önlemek ve sağlık harcamalarını azaltmak için düşmeyle ilişkili mekanizmaların anlaşılması önemlidir. Böbrek nakli alıcılarında ve böbrek nakli öncesi nakil listesinde bekleyen hastalarda risk faktörlerinin değerlendirilmesi, hasta ve hastaya bakım verenlerin eğitimi ve egzersiz programını içeren multidisipliner terapötik yaklaşımlar tasarlamak için sağlık profesyonellerinin bu özel popülasyondaki düşmelere yönelik farkındalığı artırılmalıdır.

Anahtar Kelimeler: Denge kontrolü; düşme; böbrek nakli
REFERENCES:
  1. Maia TO, Rocha LG, Bezerra SD, Marinho PEM. Functional independence and mobility in kidney transplanted patients: cross-sectional study. Motriz J Phys Educ UNESP. 2017;23(3):e101762. [Crossref] 
  2. Kosoku A, Uchida J, Nishide S, Kabei K, Shimada H, Iwai T, et al. Association of sarcopenia with phase angle and body mass index in kidney transplant recipients. Sci Rep. 2020;10(1):266. [Crossref]  [PubMed]  [PMC] 
  3. Foley RN, Wang C, Ishani A, Collins AJ, Murray AM. Kidney function and sarcopenia in the United States general population: NHANES III. Am J Nephrol. 2007;27(3):279-86. [Crossref]  [PubMed] 
  4. Bouquegneau A, Salam S, Delanaye P, Eastell R, Khwaja A. Bone disease after kidney transplantation. Clin J Am Soc Nephrol. 2016;11(7):1282-96. [Crossref]  [PubMed]  [PMC] 
  5. Nikkel LE, Hollenbeak CS, Fox EJ, Uemura T, Ghahramani N. Risk of fractures after renal transplantation in the United States. Transplantation. 2009;87(12):1846-51. [Crossref]  [PubMed] 
  6. Naylor KL, Jamal SA, Zou G, McArthur E, Lam NN, Leslie WD, et al. Fracture incidence in adult kidney transplant recipients. Transplantation. 2016;100(1):167-75. [Crossref]  [PubMed] 
  7. Ball AM, Gillen DL, Sherrard D, Weiss NS, Emerson SS, Seliger SL, et al. Risk of hip fracture among dialysis and renal transplant recipients. JAMA. 2002;288(23):3014-8. [Crossref]  [PubMed] 
  8. Carvalho TC, Dini AP. Risk of falls in people with chronic kidney disease and related factors. Rev Lat Am Enfermagem. 2020;28:e3289. [Crossref]  [PubMed]  [PMC] 
  9. Rossier A, Pruijm M, Hannane D, Burnier M, Teta D. Incidence, complications and risk factors for severe falls in patients on maintenance haemodialysis. Nephrol Dial Transplant. 2012;27(1):352-7. [Crossref]  [PubMed] 
  10. Perez-Gurbindo I, María Álvarez-Méndez A, Pérez-García R, Cobo PA, Carrere MTA. Factors associated with falls in hemodialysis patients: a case-control study. Rev Lat Am Enfermagem. 2021;29:e3505. [Crossref]  [PubMed]  [PMC] 
  11. Cook WL, Tomlinson G, Donaldson M, Markowitz SN, Naglie G, Sobolev B, et al. Falls and fall-related injuries in older dialysis patients. Clin J Am Soc Nephrol. 2006;1(6):1197-204. [Crossref]  [PubMed] 
  12. Kaltsatou A, Sakkas GK, Poulianiti KP, Koutedakis Y, Tepetes K, Christodoulidis G, et al. Uremic myopathy: is oxidative stress implicated in muscle dysfunction in uremia? Front Physiol. 2015;6:102. [Crossref]  [PubMed]  [PMC] 
  13. Hellberg M, Höglund P, Svensson P, Abdulahi H, Clyne N. Decline in measured glomerular filtration rate is associated with a decrease in endurance, strength, balance and fine motor skills. Nephrology (Carlton). 2017;22(7):513-9. [Crossref]  [PubMed] 
  14. Chu NM, Shi Z, Berkowitz R, Haugen CE, Garonzik-Wang J, Norman SP, et al. Poor outcomes in kidney transplant candidates and recipients with history of falls. Transplantation. 2020;104(8):1738-45. [Crossref]  [PubMed]  [PMC] 
  15. Plantinga LC, Lynch RJ, Patzer RE, Pastan SO, Bowling CB. Association of serious fall injuries among united states end stage kidney disease patients with access to kidney transplantation. Clin J Am Soc Nephrol. 2018;13(4):628-37. [Crossref]  [PubMed]  [PMC] 
  16. Lynch RJ, Patzer RE, Pastan SO, Bowling CB, Plantinga LC. Recent history of serious fall injuries and posttransplant outcomes among US kidney transplant recipients. Transplantation. 2019;103(5):1043-50. [Crossref]  [PubMed] 
  17. Ferro CJ, Arnold J, Bagnall D, Ray D, Sharif A. Fracture risk and mortality post-kidney transplantation. Clin Transplant. 2015;29(11):1004-12. [Crossref]  [PubMed] 
  18. World Health Organization [Internet]. [Cited: June 20, 2021]. Falls. Available from: [Link] 
  19. Zanotto T, Gobbo S, Bullo V, Vendramin B, Duregon F, Cugusi L, et al. Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy. Gait Posture. 2017;55:116-20. [Crossref]  [PubMed] 
  20. Zanotto T, Gobbo S, Bullo V, Vendramin B, Roma E, Duregon F, et al. Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: a cross-sectional study. Gait Posture. 2020;76:358-63. [Crossref]  [PubMed] 
  21. Lorenz EC, Cheville AL, Amer H, Kotajarvi BR, Stegall MD, Petterson TM, et al. Relationship between pre-transplant physical function and outcomes after kidney transplant. Clin Transplant. 2017;31(5):10.1111/ctr.12952. Erratum in: Clin Transplant. 2017;31(8) [Crossref]  [PubMed]  [PMC] 
  22. Esposito P, Furini F, Rampino T, Gregorini M, Petrucci L, Klersy C, et al. Assessment of physical performance and quality of life in kidney-transplanted patients: a cross-sectional study. Clin Kidney J. 2017;10(1):124-30. [PubMed]  [PMC] 
  23. Sedaghat S, Darweesh SKL, Verlinden VJA, van der Geest JN, Dehghan A, Franco OH, et al. Kidney function, gait pattern and fall in the general population: a cohort study. Nephrol Dial Transplant. 2018;33(12):2165-72. [Crossref]  [PubMed] 
  24. Painter JA, Elliott SJ. Influence of gender on falls. Phys Occup Ther Geriatr. 2009;27(6):387-404. [Crossref] 
  25. Abdel-Rahman EM, Yan G, Turgut F, Balogun RA. Long-term morbidity and mortality related to falls in hemodialysis patients: role of age and gender - a pilot study. Nephron Clin Pract. 2011;118(3):c278-84. [Crossref]  [PubMed] 
  26. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75(1):51-61. [Crossref]  [PubMed] 
  27. Kasbia GS, Farragher J, Kim SJ, Famure O, Jassal SV. A cross-sectional study examining the functional independence of elderly individuals with a functioning kidney transplant. Transplantation. 2014;98(8):864-70. [Crossref]  [PubMed] 
  28. Painter P, Taylor J, Wolcott S, Krasnoff J, Adey D, Tomlanovich S, et al. Exercise capacity and muscle structure in kidney recipient and twin donor. Clin Transplant. 2003;17(3):225-30. [Crossref]  [PubMed] 
  29. Harada H, Nakamura M, Hotta K, Iwami D, Seki T, Togashi M, et al. Percentages of water, muscle, and bone decrease and lipid increases in early period after successful kidney transplantation: a body composition analysis. Transplant Proc. 2012;44(3):672-5. [Crossref]  [PubMed] 
  30. Yanishi M, Kimura Y, Tsukaguchi H, Koito Y, Taniguchi H, Mishima T, et al. Factors associated with the development of sarcopenia in kidney transplant recipients. Transplant Proc. 2017;49(2):288-92. [Crossref]  [PubMed] 
  31. Abellan van Kan G, Cderbaum JM, Cesari M, Dahinden P, Fariello RG, Fielding RA, et al. Sarcopenia: biomarkers and imaging (International Conference on Sarcopenia research). J Nutr Health Aging. 2011;15(10):834-46. [Crossref]  [PubMed] 
  32. Floriano JP, Nahas PC, de Branco FMS, Dos Reis AS, Rossato LT, Santos HO, et al. Serum uric acid is positively associated with muscle mass and strength, but not with functional capacity, in kidney transplant patients. Nutrients. 2020;12(8):2390. [Crossref]  [PubMed]  [PMC] 
  33. Adachi H, Fujimoto K, Fujii A, Yamasaki K, Okada K, Matsuura T, et al. Long-term retrospective observation study to evaluate effects of adiponectin on skeletal muscle in renal transplant recipients. Sci Rep. 2020;10:1-9. [Crossref]  [PubMed]  [PMC] 
  34. Gil APP, Lunardi AC, Santana FR, Bergamim JSSP, Sarmento LA, Cristelli MP, et al. Impact of renal transplantation and immunosuppressive therapy on muscle strength, functional capacity, and quality of life: a longitudinal study. Transplant Proc. 2020;52(5):1279-83. [Crossref]  [PubMed] 
  35. van den Ham EC, Kooman JP, Schols AM, Nieman FH, Does JD, Franssen FM, et al. Similarities in skeletal muscle strength and exercise capacity between renal transplant and hemodialysis patients. Am J Transplant. 2005;5(8):1957-65. [Crossref]  [PubMed] 
  36. Kestenbaum B, Gamboa J, Liu S, Ali AS, Shankland E, Jue T, et al. Impaired skeletal muscle mitochondrial bioenergetics and physical performance in chronic kidney disease. JCI Insight. 2020;5(5):e133289. [Crossref]  [PubMed]  [PMC] 
  37. Hariharan S, McBride MA, Cherikh WS, Tolleris CB, Bresnahan BA, Johnson CP. Post-transplant renal function in the first year predicts long-term kidney transplant survival. Kidney Int. 2002;62(1):311-8. [Crossref]  [PubMed] 
  38. Veenhof H, Koster RA, Alffenaar JC, Berger SP, Bakker SJL, Touw DJ. Clinical validation of simultaneous analysis of tacrolimus, cyclosporine a, and creatinine in dried blood spots in kidney transplant patients. Transplantation. 2017;101(7):1727-33. [Crossref]  [PubMed] 
  39. Odden MC, Shlipak MG, Tager IB. Serum creatinine and functional limitation in elderly persons. J Gerontol A Biol Sci Med Sci. 2009;64(3):370-6. [Crossref]  [PubMed]  [PMC] 
  40. Tekkarismaz N, Doruk Analan P, Ozelsancak R, Torun D, Caliskan K, Haberal M. Effect of kidney transplant on balance and fall risk. Exp Clin Transplant. 2020;18(Suppl 1):73-7. [Crossref]  [PubMed] 
  41. Diabetes Canada Clinical Practice Guidelines Expert Committee; McFarlane P, Cherney D, Gilbert RE, Senior P. Chronic Kidney Disease in Diabetes. Can J Diabetes. 2018;42 Suppl 1:S201-S209. [Crossref]  [PubMed] 
  42. Sharif A, Baboolal K. Complications associated with new-onset diabetes after kidney transplantation. Nat Rev Nephrol. 2011;8(1):34-42. [Crossref]  [PubMed] 
  43. Malabu UH, Vangaveti VN, Kennedy RL. Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review. Clin Epidemiol. 2014;6:287-94. [Crossref]  [PubMed]  [PMC] 
  44. Berlie HD, Garwood CL. Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacother. 2010;44(4):712-7. [Crossref]  [PubMed] 

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