Full length articleBalance impairment in kidney transplant recipients without concurrent peripheral neuropathy
Introduction
End stage renal disease (ESRD), is a disorder characterized by increasing incidence and prevalence worldwide [1]. In 2003, about 1,7 million patients affected by chronic kidney disease (CKD) were estimated to be undergoing renal replacement therapy (RRT), and among these, over 300000 were living with a kidney transplant [2].
Renal transplantation ideally represents the preferred treatment modality for patients with ESRD [3], as kidney transplant recipients (KTRs) have been shown to have prolonged survival and improved CKD-related quality of life compared to dialysis patients [4].
Although post-transplantation improvement in quality of life can lead to increased levels of physical activity [5], the levels achieved still remain lower than that seen in the general population.
Moreover, KTRs also present with compromised functional capacity that reflects the combined effects of deconditioning, muscle atrophy and immunosuppressive therapy [6].
The prevalence of sarcopenia and frailty is also high amongst KTRs and seems to occur at a younger age compared to the general population [7].
Postural instability has been identified as one of the main factors that can lead to adverse outcomes such as falls in elderly people. Given the prevalence of poor physical functioning and pharmacologic therapy amongst KTRs, both of which are implicated in the aetiology of falls in the elderly, it is plausible to suggest that people living with a renal transplant may thus also be at increased risk of falling.
Muscle atrophy, commonly reported in KTRs, has consistently been associated with impaired postural control [8] and increased risk of falling. In addition, the side effects of immunosuppressive therapy, that include central neurologic disorders, such as tremors, and peripheral neuropathy [9] may also hinder the postural control of KTRs. In particular, peripheral nerve dysfunction is associated with calcineurin inhibitors use in KTRs [10] and is one of the mechanisms that may lead to postural instability [11].
Laboratory based studies have shown that, in static balance conditions, CKD patients undergoing haemodialysis (HD) therapy exhibit increased postural sway when compared to age and body mass matched healthy individuals [12], [13], with further impairment of postural control evident during the execution of a concurrent cognitive task [13].
ESRD patients are usually characterized by a higher grade of cognitive impairment than people at the early stages of CKD [14]. In KTRs, alterations of the mental status may represent a symptom of a central nervous system infection, a common complication of renal transplantation, which is associated with the amount of immunosuppression [9].
The purpose of this exploratory study was to compare static balance control in KTRs with healthy adults (HA). We hypothesised that KTRs will be more unsteady than HA and also that the performance of a concurrent cognitive task will highlight an increased deterioration of static balance in KTRs compared to HA.
At the best of our knowledge, this is the first study investigating static balance control in KTRs.
Section snippets
Participants
Nineteen KTRs and nineteen HA were recruited respectively from patients of the Sport and Exercise Medicine Division, Department of Medicine (University of Padova, Italy), or from a public announcement visible on the notice board in the same division.
Both patients and healthy volunteers expressing a preliminary interest in the research project were provided a participant information sheet and written informed consent was sought and obtained.
Upon consent, a medical history questionnaire to assess
Results
Demographic results are reported in Table 1.
The GPAQ highlighted lower physical activity scores for KTRs compared to HA. The weekly duration in minutes of moderate to vigorous physical activities, was lower in KTRs (p = 0.009) as highlighted by the Mann-Whitney U test. In addition, a Chi-Squared test confirmed the higher proportion of physical inactivity among KTRs (p = 0.001), with a Phi value of φ = 0.563, indicating a large effect size.
Fig. 1 displays the differences between KTRs and HA in the
Discussion
The primary finding of the current study is that overall postural control was lower in KTRs compared with HA.
The GPAQ results revealed that physical inactivity was higher in KTRs compared to HA (p=0.001; φ=0.563), therefore we sought to control the two groups for physical activity levels, with the ANCOVA design. By doing so, we decreased the chances of finding lower balance as a result of a general physical deconditioning due to the overall detrimental effects of physical inactivity on balance
Conflicts of interest
None.
The results presented in this paper have not been published previously in whole or part, except in abstract format.
Disclosure
The authors of this manuscript have no conflict of interest.
Acknowledgements
The study was not supported by any funding or grant.
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