Original investigations
Dialysis therapies
Falls in hemodialysis patients: Prospective study of incidence, risk factors, and complications

https://doi.org/10.1053/j.ajkd.2004.09.027Get rights and content

Background: Falls are common in elderly nonuremic patients and are associated with poor outcomes. Recent international guidelines recommend proper assessment of fallers and those at risk for falling to implement multidimensional preventative strategies. Surprisingly, the incidence, risk factors, and complications of falls in hemodialysis (HD) patients are unknown despite the growing number of elderly patients on HD therapy worldwide. Methods: We contacted all patients from 7 Belgian in-center HD units. Consenting patients were evaluated in March 2001 for the presence of risk factors for falling (demographics, selected comorbid conditions, gait/balance tests, main biochemical markers, and drug and HD regimens). Falls (including circumstances and derived complications) subsequently were recorded by staff members of all 7 units for 8 weeks from April 1, 2001, through questioning of patients, relatives, and caregivers. Fractures consecutive to falls were recorded for 12 months. Results: Three-hundred eight patients agreed to participate (acceptance rate, 94%). They had a median age of 70.9 years (56% men, 27% patients with diabetes). Thirty-nine patients (12.7%) with a median age of 74.7 years fell at least once during the 8 weeks (total, 56 falls), an average incidence of 1.18 fall/patient-year. One third of the falls caused lesions requiring health care or even hospitalization (n = 6). During 12 months, 12 patients (3.9%) experienced a fall-related fracture. Logistic regression identified older age (odds ratio, 1.057/y; P = 0.01), diabetes (odds ratio, 2.747; P = 0.02), high number of prescribed oral drugs (odds ratio, 1.19/drug; P = 0.011), antidepressant use (odds ratio, 5.263; P < 0.001), and failing to walk 10 m without help (odds ratio, 2.057; P = 0.001) as independent risk factors for falling. Conclusion: Falls are common in in-center HD patients. The high-risk population delineated by our logistic model appears as a priority target for intervention studies (including exercise programs and more selective prescription of some drugs in particular) to reduce the incidence and complications of falls.

Section snippets

Definition of a fall

A fall is defined as an event that results in coming inadvertently to the ground. Unintentional falls onto a chair or bed, as well as impacts against an object during which the subject did not come to rest on the ground, thus were excluded.7 A serious fall is defined as a fall causing a fracture, requiring hospitalization, or causing death.

Study design

All patients on thrice-weekly HD therapy for longer than 3 months in 7 Belgian in-center HD units were asked to participate in the study. Within 1 month, all

Included patients

Three hundred thirty-nine patients were asked to participate. During the baseline (1-month) evaluation period, dropouts were caused by death (n = 5), transfer to nonparticipating HD units (n = 5), or renal transplantation (n = 1). Eventually, 308 of 328 eligible patients (94%) agreed to participate. The participation rate varied from 76% to 100% (median, 99%) in the 7 participating units. The 308 participating patients (174 men) had a median age of 70.9 years (range, 25.3 to 92.8 years). They

Discussion

We prospectively studied the incidence, risk factors, and complications of falls in long-term HD patients. None of these aspects had yet been assessed, even retrospectively, despite the well-known substantial incidence of falls in elderly nonuremic patients,5, 7 the growing number of elderly HD patients in the United States and Europe,15, 16 and the growing interest for geriatrics in nephrology and dialysis.17, 18

The incidence of falls in HD patients was high: 1.18 fall/patient-year.

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    Participating members of the Université Catholique de Louvain Collaborative Group: D. Becker, P. Bernis, J.L. Christophe, C. Cuvelier, R. Cuvelier, I. Devriendt, J. Ghysen, J. Jamez, G. Loute, J.M. Pochet, A. Quoidbach, F. Reginster, M. Wauthier (nephrologists), M.H. Cornet, A.P. De Man, M. Denis, F. Dental, F. Devergnies, A. Ghislain, G. Gregoire, A. Naze, F. Pegard, C. Saintenoy, N. Soenen, M. Vanderputten, R. Vanrusselt, and J. Wasterlain (members of HD nursing staffs).

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