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
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