Gait and Balance in People Undergoing Long-Term Hemodialysis

Anyone who has been in the waiting room of a hemodialysis clinic will be struck by the number of patients who require canes, walkers, rollators, and wheelchairs. I am a 75-year-old White individual with kidney failure. I was on 3-days-per-week hemodialysis, and I use a cane. I don't need the cane, but while waiting for a kidney transplant, I was advised to use one specifically to help guard against a fall, breaking a hip, and being disqualified for a transplant.

In many clinical encounters, after having successfully recited their birth date, patients will be asked, “Have you fallen in the past year (or month or 6 months, depending on the protocol)?” Clearly, balance is an important issue among a large percentage of kidney patients, even aside from orthostatic hypertension arising from being in the classic dialysis position for nearly 4 hours. The dangers of a fall—whether against a hard object or a “free fall” to the ground—are potentially life-threatening to an elderly person of even good health, much less a dialysis patient.

A team of researchers from Japan, writing an article published in this issue of CJASN,¹ noted “the incident rate of falls among hemodialysis patients is 1.18–1.60 per patient-year, which is much higher than that in the general older population (≥65 years), at approximately 0.67 per person-year.”¹

Asahina et al.¹ devised a study to determine if external stimulation—a vibrating platform on which the patients stood to induce whole-body vibration—had an effect on balance and gait. According to the authors, this has proven to have some efficacy in “improving gait speed and dynamic balance among very old and frail individuals.”¹

The 12-week study included patients aged 65 years and younger who could walk unaided whether or not they (like me) used a walking aid. The patients were instructed to stand on the platform holding a handrail, with bent knees for 3 minutes. The exercise was conducted on hemodialysis days before treatment began.

The study included 98 patients. They were split into two groups (N=49), with half using the whole-body vibrator and half not. Three tests were included: (1) Timed Up and Go, (2) single-leg stand, and (3) 30-second chair stand.

The research team reported there were no serious adverse effects exhibited by the participants, “however, whole-body vibration did not improve gait ability and balance, as assessed by the physical performance tests.”¹

The authors did point out that:

Although there are few studies examining the efficacy of balance training in hemodialysis patients, Frih et al. reported that a 24-week program with balance training (30 min/session) four times a week on nondialysis days improved the postural balance of hemodialysis patients when included in a usual endurance-resistance training monitored by profession balance of hemodialysis patients when included in a usual endurance-resistance training monitored by professional physiologists.¹

The results of this study indicate that if there are shortcuts to improving gait and balance in hemodialysis patients, the whole-body vibrator does not appear to be it.

Active exercise for older and/or frail patients is “often difficult and demanding, which results in reluctance to continue such training,” the article states.¹ Asahina et al.¹ suggest that the 12-week length of the study and relatively short duration of each session might warrant further studies by increasing both.

Nevertheless, the issue of gait and balance in older hemodialysis patients is real and, as the population as a whole ages, possibly growing. The authors argue for continuing studies to “determine the efficacy and adherence of longer and more intense whole-body vibration training for hemodialysis patients.”¹

Disclosures

The author has nothing to disclose.

Funding

None.

Author Contributions

R. Galen wrote the original draft.