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Updated: Jun 4, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Balance in children with chronic kidney disease: the relationship between skeletal muscle mass index, fatigue, and
Muharrem Yüksel1, Dilek Durmuş1, Hülya Nalçacıoğlu2
1Department of Physical Medicine and Rehabilitation, Medical Faculty, Ondokuz Mayis University, Samsun, Turkey.
Insights
Children with chronic kidney disease (CKD) show reduced muscle mass, strength, and balance, especially those on dialysis. Early rehabilitation is crucial to improve outcomes and address balance impairments linked to fatigue and declining function.
Area of Science:
- Pediatric Nephrology
- Rehabilitation Medicine
- Clinical Physiology
Background:
- Children with chronic kidney disease (CKD) often experience impaired physical function and fatigue.
- The relationship between balance, skeletal muscle mass index (ASMI), physical function, and fatigue in pediatric CKD is not fully understood.
Purpose of the Study:
- To evaluate the association between balance function and ASMI, physical function, and fatigue in children with CKD.
- To identify factors influencing balance in children with CKD.
Main Methods:
- Cross-sectional study involving 83 children with CKD (stages 1-4, dialysis, transplant) and 71 healthy controls.
- Assessed gait speed, 6-min walk distance (6MWD), five-repetition sit-to-stand (5RST), timed up-and-go (TUG), quadriceps muscle strength (QMS), hand grip strength (HGS), ASMI via bioelectrical impedance analysis (BIA), fatigue (Child Fatigue Scale), and balance (Pediatric Balance Scale).
- Multivariate linear regression analyzed factors influencing balance in the CKD cohort.
Main Results:
- Children with CKD demonstrated significantly lower muscle strength, physical performance, and balance compared to controls.
- The dialysis group exhibited the most pronounced deficits in ASMI, muscle strength, physical performance, and balance, along with the highest fatigue levels.
- Regression analysis identified QMS, ASMI, gait speed, TUG, GFR, and lean mass as significant predictors of balance in children with CKD.
Conclusions:
- The dialysis group shows the most significant physical impairments and fatigue.
- Balance in children with CKD is primarily influenced by fatigue, ASMI, QMS, and functional capacity.
- Early rehabilitation programs are essential to mitigate the negative impact of balance impairments on prognosis in pediatric CKD patients.
Background:
The study evaluated the relationship between balance function and skeletal muscle mass index (ASMI), physical function, and fatigue in children with chronic kidney disease (CKD).
Methods:
A cross-sectional study of 83 children with CKD (stages 1-4, dialysis, transplant) and 71 healthy controls was conducted. Functional performance tests, including gait speed, 6-min walk distance (6MWD), five-repetition sit-to-stand (5RST), and timed up-and-go (TUG) tests, were administered. Quadriceps muscle strength (QMS) and hand grip strength (HGS) were assessed alongside bioelectrical impedance analysis (BIA) for muscle mass evaluation. Fatigue was measured using the Child Fatigue Scale, and balance was assessed using the Pediatric Balance Scale. Multivariate linear regression, performed exclusively on the CKD cohort, was used to determine factors influencing balance.
Results:
Children with CKD exhibited significantly lower muscle strength, physical performance, and balance than controls. Specifically, QMS on the right side was 7.16 ± 5.36 kg in the dialysis group versus 16.51 ± 8.66 kg in the CKD stages 1-4 group and 18.58 ± 7.27 kg in controls (p < 0.001). The 6MWD was 392 ± 50.34 m in the dialysis group compared to 476 ± 49.67 m in CKD stages 1-4 and 425 ± 68.94 m in controls (p < 0.001). Fatigue levels were highest in the dialysis group (41.00 ± 11.51), and balance scores were lowest in this group (47.71 ± 8.55) (p = 0.001 for both). Regression analysis showed that QMS (β = 0.333, p = 0.042), ASMI (β = 0.259, p = 0.043), gait speed (β = -0.347, p = 0.012), TUG (β = -0.656, p = 0.001), GFR (β = 0.238, p = 0.033), and lean mass (β = 0.710, p = 0.028) were significant predictors of balance.
Conclusions:
The dialysis group presented the most significant reductions in ASMI, muscle strength, balance, and functional performance, alongside the highest fatigue levels. Balance was mainly influenced by fatigue, ASMI, QMS, and declining functional capabilities. Considering the negative impact of balance impairments on prognosis, early implementation of rehabilitation programs is essential for improving outcomes in CKD patients.
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