Portable, Non-Invasive Fall Risk Assessment in End Stage Renal Disease Patients on Hemodialysis

Patients with end stage renal diseases (ESRD) on hemodialysis (HD) have high morbidity and mortality due to multiple causes, one of which is dramatically higher fall rates than the general population. The mobility mechanisms that contribute to falls in this population must be understood if adequate interventions for fall prevention are to be achieved. This study utilizes emerging noninvasive, portable gait, posture, strength, and stability assessment technologies to extract various mobility parameters that research has shown to be predictive of fall risk in the general population. As part of an ongoing human subjects study, mobility measures such as postural and locomotion profiles were obtained from five (5) ESRD patients undergoing HD treatments. To assess the effects of post-HD-fatigue on fall risk, both the pre- and post-HD measurements were obtained. Additionally, the effects of inter-HD periods (two days vs. three days) were investigated using the non-invasive, wireless, body-worn motion capture technology and novel signal processing algorithms. The results indicated that HD treatment influenced strength and mobility (i.e., weaker and slower after the dialysis, increasing the susceptibility to falls while returning home) and interdialysis period influenced pre-HD profiles (increasing the susceptibility to falls before they come in for a HD treatment). Methodology for early detection of increased fall risk – before a fall event occurs – using the portable mobility assessment technology for out-patient monitoring is further explored, including targeting interventions to identified individuals for fall prevention

Effects of hemodialysis therapy on sit-to-walk characteristics in end stage renal disease patients

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of postural and locomotor performance in elderly patients with functional limitations indicative of fall risks. In order to assess the effects of HD therapy on fall risks, 22 sessions of both pre- and post-HD measurements were obtained in six ESRD patients utilizing customized inertial measurement units (IMU). IMU signals were denoised using ensemble empirical mode decomposition and Savistky-Golay filtering methods to detect relevant events for identification of STW phases. The results indicated that patients were slower to get out of the chair (as measured by trunk flexion angular accelerations, time to peak trunk flexion, and overall STW completion time) following the dialysis therapy session. STW is a frequent movement in activities of daily living, and HD therapy may influence the postural and locomotor control of these movements. The analysis of STW movement may assist in not only assessing a patient's physical status, but in identifying HD-related fall risk as well. This preliminary study presents a non-invasive method of kinematic measurement for early detection of increased fall risk in ESRD patients using portable inertial sensors for out-patient monitoring. This can be helpful in understanding the pathogenesis better, and improve awareness in health care providers in targeting interventions to identify individuals at risk for fall

Effects of Hemodialysis Therapy on Sit-to-Walk Characteristics in End Stage Renal Disease Patients

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of postural and locomotor performance in elderly patients with functional limitations indicative of fall risks. In order to assess the effects of HD therapy on fall risks, 22 sessions of both pre- and post-HD measurements were obtained in six ESRD patients utilizing customized inertial measurement units (IMU). IMU signals were denoised using ensemble empirical mode decomposition and Savistky-Golay filtering methods to detect relevant events for identification of STW phases. The results indicated that patients were slower to get out of the chair (as measured by trunk flexion angular accelerations, time to peak trunk flexion, and overall STW completion time) following the dialysis therapy session. STW is a frequent movement in activities of daily living, and HD therapy may influence the postural and locomotor control of these movements. The analysis of STW movement may assist in not only assessing a patient’s physical status, but in identifying HD-related fall risk as well. This preliminary study presents a non-invasive method of kinematic measurement for early detection of increased fall risk in ESRD patients using portable inertial sensors for out-patient monitoring. This can be helpful in understanding the pathogenesis better, and improve awareness in health care providers in targeting interventions to identify individuals at risk for fall

A combined strength and balance exercise program to decrease falls risk in dialysis patients : a feasibility study

People suffering end-stage kidney disease receiving hemodialysis have a greater risk of falling and suffering debilitating injuries. The purpose of this study was to examine the feasibility and impact of a combined strength and balance exercise intervention on falls risk in hemodialysis patients. Twenty-four adults (mean age = 67.8 yrs) from two Australian outpatient hemodialysis clinics completed the intervention. Falls risk was measured using the Physiological Profile Assessment (PPA). There was a significant reduction in the median overall falls risk z-score from 1.67 to .52 (z = -3.11, P<.008; r = .45). Median reaction time improved from .30 to .26 sec (z = -2.86, P<.008; r = .41). A strength and balance intervention to reduce the falls risk for dialysis patients is feasible and may reduce falls risk for at risk patients

Ann Biomed Eng

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of postural and locomotor performance in elderly patients with functional limitations indicative of fall risks. In order to assess the effects of HD therapy on fall risks, 22 sessions of both pre- and post-HD measurements were obtained in six ESRD patients utilizing customized inertial measurement units (IMU). IMU signals were denoised using ensemble empirical mode decomposition and Savistky-Golay filtering methods to detect relevant events for identification of STW phases. The results indicated that patients were slower to get out of the chair (as measured by trunk flexion angular accelerations, time to peak trunk flexion, and overall STW completion time) following the dialysis therapy session. STW is a frequent movement in activities of daily living, and HD therapy may influence the postural and locomotor control of these movements. The analysis of STW movement may assist in not only assessing a patient's physical status, but in identifying HD-related fall risk as well. This preliminary study presents a non-invasive method of kinematic measurement for early detection of increased fall risk in ESRD patients using portable inertial sensors for out-patient monitoring. This can be helpful in understanding the pathogenesis better, and improve awareness in health care providers in targeting interventions to identify individuals at risk for fall.L30 AG022963/AG/NIA NIH HHS/United StatesL30-AG022963-04/AG/NIA NIH HHS/United StatesR01-OH009222/OH/NIOSH CDC HHS/United States2014-04-01T00:00:00Z23212801PMC360669

Ultrasound measurements on the inferior vena cava by renal nursing staff for assessment and management of intravascular volume status in haemodialysis patients

Title: Ultrasound measurements on the inferior vena cava (IVC-US) by renal nursing staff for assessment and management of intravascular volume status in haemodialysis patients. Aims: The primary aim of this thesis was to provide evidence that renal nurses could safely and efficiently perform IVC-US on haemodialysis patients to obtain objective assessment of intravascular volume status and potentially reduce adverse events and morbidity. The secondary aims for this study were: (1) conduct a systematic literature review to identify evidence if renal nurses have previously used this method for intravascular volume assessment; (2) teach a renal nurse through a staged educational programme, guided by a medically trained ultrasonographer, a sonologist, to gain competency in ultrasound image acquisition and interpretation of the scans; (3) measure the prevalence of any form of intradialytic hypotension in a satellite haemodialysis clinic over a three-month period and (4) attain concurrent IVC-US and bioimpedance spectroscopy measurements on 30 patients during their haemodialysis treatment and to compare these findings with their intravascular volume status using the traditional clinical nursing assessment method. Materials and Methods: To achieve this primary aim, this thesis was separated into multiple phases. First, a systematic literature review of medical and nursing databases was performed to summarise the use of IVC-US in haemodialysis patients by renal nurses. The second phase involved a retrospective data analysis, where the prevalence rate of nurse-documented fluid related intradialytic hypotensive events was measured and a Generalised Estimating Equation (GEE) model was used to predict the likelihood of any form of intradialytic hypotension or postdialytic overhydration. In the next phase a four-step educational programme was developed in collaboration with an expert sonologist, guiding the renal nurse through the process of skill acquisition and accurate fluid assessment based on nurse-performed IVC-US scans. Following this phase, and after receiving theoretical training and performing 100 proctored scans, the renal nurse then performed 60 IVC-US scans independently, which were subsequently assessed by two sonologists, resulting in a cross-sectional interrater study, confirming competency. The final phase of the thesis consisted of a simulative pilot study, where 30 haemodialysis patients were assessed during three intradialytic moments of a single session on their intravascular volume status with IVC-US. Results: The systematic literature review revealed that there is a paucity of knowledge regarding renal nurses and IVC-US. The 3-month data analysis has shown that intradialytic hypotension (IDH) was still the most common adverse intradialytic event with 13.1% of all treatments affected. The renal nurse mastered the educational programme and was deemed competent by the experts. Finally, the simulative pilot study revealed that if IVC-US had been performed and indicated intravascular hypovolemia, patients had a 14-fold chance to experience subsequent IDH events. An algorithm using IVC-US combined with bioimpedance spectroscopy (BIS) and mean arterial pressure (MAP) revealed a sensitivity of 95% and a specificity of 100% for the prevention of IDH. Conclusions: This thesis demonstrates the obvious need for more objective and reliable fluid assessment methods in the haemodialysis population to improve clinical outcomes. Most importantly, it has been shown that renal nurses can master the skill to perform IVC-US and that IVC-US is a useful and reliable method of fluid assessment. Performing IVC-US is a transferrable skill and has potential to be preventative for intradialytic hypotension if added to the clinical fluid assessment routine by renal nurses. It has potential to change clinical practice and policy in future, but further research studies are needed to provide evidence for this

The prognostic role of finger pressures and access flows in hemodialysis patients

Patients with renal failure undergoing haemodialysis via a dialysis access in the arm have a significantly lower survival compared to healthy people. In addition, they stand a higher risk of complications including a painful dialysis hand and heart failure. The aim of the present PhD research was to identify predictors of these complications and patient survival. Data suggest that a simple measurement of finger blood pressure, prior to initiation of hemodialysis, may predict the onset of hand pain due to diminished hand blood flow. It also appears that serial measurements of (changes in) the amount of blood through the dialysis access (‘access flow’) may contribute to the prediction of the risk of cardiac death. Future research will determine whether measurements of finger pressures and access flow may aid in optimizing the treatment of patients with renal failure