Patients with chronic kidney disease on hemodialysis have physical function impairment, which, added to the effects of the dialysis process, contributes to an increase in the risk of falls in these patients. The history of falls is associated with fear of falling in hemodialysis patients, but its relationship with physical function and quality of life requires investigation.

To compare physical function and quality of hemodialysis patients with normal and high fear of falling

A cross-sectional study was carried out with patients aged 18 years or older, with chronic kidney disease and on HD for at least three months. Patients unable to perform the assessments, who had psychiatric impairments and severe and/or unstable comorbidity were excluded. Fear of falling was assessed using the Falls Efficacy Scale-International, whose score was used to classify patients into normal (<25) and higher (≥25) fear of falling groups. Physical function was assessed by muscle strength of upper limb (hand grip - HG) and lower limbs (5 repetitions sit and stand test - STS5), walking speed (4.6 meters), functional mobility (Timed up and Go - TUG) and dynamic postural balance (Mini Balance Evaluation Systems Test - Mini-BESTest). In addition to the physical activity level questionnaires (Human Activity Profile - HAP) and quality of life (36-Item Short Form Health Survey-SF-36, by physical and mental summary components). Data normality was verified using the Shapiro-Wilk test. Comparisons between groups were performed using the Student's t-test or Mann-Whitney test. The significance level was p<0.05.

A total of 112 patients (58.7±12.9 years; 56.3% male) were evaluated, of which 55.4% were classified as normal and 44.6% a higher fear of falling. The higher fear of falling group performed worse on the HG[24.0(12.0) vs. 30.0(18.0) kilograms strength; p<0.001)], STS5 [14.6(5.3) vs. 11.5(5.5) seconds; p=0.002] tests, gait speed (1.2±0.2 vs. 1.4±0.3 meters/second; p=0.004), TUG [8.8(2.4) vs. 7.8(2.8) seconds; p=0.009], and Mini-BESTest [21.0(3.0) vs. 23.0(5.0); p=0.026] compared to the normal fear of falling group. Furthermore, the same group showed worse scores on the HAP (52.0±14.7 vs. 60.7±12.6; p=0.001) and physical (39.3±8.5 vs. 45.9 ±8.9; p<0.001) and mental [28.5(23.7) vs. 41.9(29.4); p=0.004] summary components of the SF-36.

Patients with higher fear of falling had worse performance in physical function, lower level of physical activity and greater impairment of quality of life compared to those with normal fear of falling.

Interventions that reduce the fear of falling can contribute to improving physical function, increasing the level of physical activity, and reducing the impairment of the quality of life of patients on hemodialysis.