Aplicabilidade da mensuração de circunferência de panturrilha como preditor de risco de quedas e fraturas em idosos com doença renal crônica em hemodiálise

Abstract

During the human aging process, there is an increased risk of developing diseases such as chronic kidney disease (CKD), a progressive, silent and irreversible pathology, that has been negatively affecting the entire population, including the elderly. About 30 to 40% of the elderly fall at least once a year, a risk that increases in individuals with CKD who undergone hemodialysis (HD). The calf circumference measurement (CC) is an easy, low cost and non-invasive measure, already used to check muscle mass in the elderly. A prospective study was outlined with the hypothesis that the CC measurement would be able to predict the risk of falls in elderly people in HD treatment. The objectives of the present study were: to assess the ability of the CC measure to predict the risk of falls and fractures in elderly people on HD. Specific objectives were: to assess the prevalence of decreased CC, to correlate the CC measurement with clinical, demographic, and biochemical factors, ankle-brachial pressure index (ABI) and handgrip strength (HGS), with other nutritional measures such as serum levels of albumin, cholesterol, and phosphorus, as well as the degree of physical fitness fall and fractures. This was a prospective study that included 91 elderly patients with CKD on maintenance HD from 2 dialysis services (age 73.7  5.4 years, 69.2% men, 56% with diabetes). The mean CC was 32.6  3.7 cm, with a high prevalence of low muscle mass measured by CC in the study population (61.5%). After the initial approach, the subjects were followed for six months. During this period of time, 13 fall patients were identified, one fall followed by fracture and death. It was observed that both advanced age and high weight were factors associated with falls. None of other variable was correlated to fall, including laboratory results, ABI, HGS pr DASI scores. A logistic regression model was applied to select covariates of interest. CC, age, and weight remained significant in the final model. Therefore, after adjusting for age and weight, the chance of falling in the elderly with decreased CC is 6.9 times greater than in the elderly with normal CC. It was concluded that an association with age and weight, the decreased CC was able to predict fall in elderly patients on HD.