Impact of Kidney Disease/Failure on Mobility

Impact of Kidney Disease/Failure on Mobility. Understanding physical challenges caused by kidney conditions.

[Audio] Kidney Disease in Acute Care, Kidney Function – Why It Matters for Mobility.

[Audio] End-Stage Kidney Disease (ESKD) and Acute Kidney Injury (AKI) are common conditions encountered in acute care settings. ESKD represents a progressive loss of kidney function requiring renal replacement therapy such as dialysis or transplantation. AKI, on the other hand, is a sudden decline in renal function, often reversible with timely intervention. In general medical wards, patients with kidney disease often present with multiple comorbidities including diabetes, congestive cardiac failure (CCF), and sepsis. These conditions contribute to fatigue, fluid overload, hypotension, and significant deconditioning, all of which impact a patient's mobility and functional independence. Understanding the pathophysiology and clinical presentation of kidney disease is essential for physiotherapists to tailor safe and effective rehabilitation strategies for these patients..

[Audio] The kidneys play a crucial role in maintaining homeostasis through fluid and electrolyte regulation, erythropoietin production, and blood pressure control. Electrolyte imbalances, such as hyperkalemia or hypocalcemia, can lead to muscle weakness, cramps, and cardiac arrhythmias, directly affecting a patient's ability to mobilize safely. Anemia, resulting from decreased erythropoietin production, reduces oxygen delivery to tissues, leading to fatigue and decreased exercise tolerance. Additionally, impaired activation of vitamin D can compromise bone health, increasing the risk of fractures. Blood pressure dysregulation, particularly postural hypotension, is common in renal patients and can lead to dizziness and falls. These physiological changes necessitate careful assessment and monitoring by physiotherapists to ensure safe mobilization and to prevent complications..

[Audio] Dialysis Modalities & Mobility Implications, Dialysis Access & Safety.

[Audio] Dialysis is a life-sustaining treatment for patients with ESKD and is delivered through two primary modalities: Peritoneal Dialysis (PD) and Haemodialysis (HDx). PD involves exchanges of dialysate fluid via a Tenckhoff catheter, using the peritoneum as a natural filter. Patients undergoing PD should not be mobilized during exchanges. HDx, typically performed about 3 days per week for 4–6 hours per session, uses an external machine to filter the blood. Post-dialysis, patients often experience fatigue, hypotension, and dizziness, which can hinder their ability to participate in physiotherapy. It is advisable to schedule physiotherapy sessions before or well after dialysis to optimize patient engagement and safety. Understanding the type and timing of dialysis is essential for physiotherapists to plan effective interventions..

[Audio] Common Presentations Impacting Mobility, Physiotherapy Management Strategies, Diabetes & Dialysis: Wound Healing and Amputations.

[Audio] Patients with kidney disease often present with a range of complications that significantly impact mobility. Fluid overload and congestive cardiac failure (CCF) can lead to breathlessness and reduced exercise tolerance. Acute kidney injury (AKI) may result in rapid deconditioning. Amputations, particularly below-knee (BKA) and above-knee (AKA), are prevalent due to vascular complications and require early rehabilitation. Diabetes and peripheral vascular disease increase the risk of foot ulcers and poor wound healing, further limiting mobility. Cognitive impairments, common in this population, can affect safety and participation in therapy. Falls and functional decline are frequent, necessitating comprehensive assessment and individualized physiotherapy plans to address these multifactorial challenges..

[Audio] Effective physiotherapy management of patients with kidney disease involves thorough assessment and tailored interventions. Key areas of focus include evaluating functional mobility, fatigue levels, vital signs, and cognitive status. Interventions may encompass bed mobility training, assisted transfers, and gait re-education. It is crucial to avoid scheduling therapy sessions immediately post-dialysis due to common symptoms such as fatigue and hypotension. Collaboration with multidisciplinary teams, including podiatry, vascular surgery, nursing, and occupational therapy, ensures comprehensive care. Physiotherapists should also be aware of dialysis schedules, access types, and any mobility restrictions to plan safe and effective rehabilitation sessions. Flexibility and communication are essential in adapting to the dynamic nature of acute care settings..

[Audio] Diabetes is a leading cause of End-Stage Kidney Disease (ESKD) and significantly complicates the rehabilitation of dialysis patients. Poor glycaemic control impairs wound healing and increases the risk of infections, particularly in the lower limbs. Peripheral vascular disease and neuropathy are common, leading to a high incidence of foot ulcers and delayed healing. These complications often result in lower limb amputations, such as below-knee (BKA) or above-knee amputations (AKA). Physiotherapists must be vigilant in monitoring wound sites and dressings during mobility sessions. Collaboration with podiatry and vascular teams is essential to determine weight-bearing status and obtain clearance for mobilization. Early physiotherapy intervention post-amputation is critical to prevent further deconditioning and to facilitate functional recovery and independence..

[Audio] Functional Decline in Hospital, Summary & Questions.

[Audio] Functional decline can begin within 48 hours of hospital admission, particularly in older adults and those with chronic conditions like kidney disease. Prolonged bed rest, reduced activity, and medical interventions contribute to deconditioning, muscle atrophy, and loss of independence. Early mobilisation and incidental activity are key strategies to mitigate these effects. Physiotherapists should use validated tools to assess mobility risk and implement individualized interventions to maintain or improve function. Encouraging patients to participate in daily activities, even simple tasks like sitting out of bed or walking short distances, can significantly impact recovery outcomes. Awareness of these risks and proactive management are essential components of physiotherapy in acute care settings..

[Audio] Kidney disease impacts mobility through a combination of physiological, systemic, and psychosocial factors. Understanding the types of dialysis, access precautions, and common patient presentations enables physiotherapists to deliver safe and effective care. Collaboration with multidisciplinary teams and awareness of dialysis schedules are essential for planning interventions. Physiotherapists play a vital role in preventing functional decline, promoting independence, and supporting recovery in patients with kidney disease. This presentation has provided an overview of key considerations and strategies for managing mobility in this complex patient population. Questions and discussion are encouraged to further explore practical applications and share experiences..