Are elderly haemodialysis patients at risk of falls and postural hypotension?
BACKGROUND
The numbers of older people on haemodialysis is rising. As aging and renal failure are risk factors for autonomic failure and haemodialysis involves significant fluid shifts we hypothesized that older patients would be susceptible to hypotensive events between dialysis sessions. Postural hypotension is a risk factor for falls. Falls are debilitating and a leading cause of morbidity and mortality in the elderly.


OBJECTIVE
To investigate whether postural hypotension and symptoms of hypotension and falls are common in older haemodialysis patients.


METHODS
All 47 patients from a single unit aged 70 or over were asked about falls in the previous year and about symptoms that could be due to hypotension (syncope, presyncope, dizziness) between dialysis sessions. Twenty-three patients underwent pre- and post-dialysis orthostatic blood pressure measurement, 18 had 44 hour ambulatory blood pressure recording and 10 subjects had full autonomic function testing.


RESULTS
Of 47 patients interviewed, 20 reported syncope/pre-syncope, 34 reported dizziness and 14 recalled at least one fall in the previous year. 8/23 had orthostatic hypotension pre-dialysis and 16/23 post-dialysis. Mean 44-hour blood pressure was 134/68 (+/- 21/9) with no nocturnal dip. Autonomic function was abnormal in all 10 subjects tested.


CONCLUSIONS
Elderly haemodialysis patients have a high incidence of hypotensive symptoms between dialysis sessions, recalled falls in the previous year and significant postural hypotension post-dialysis. Physicians supervising elderly haemodialysis patients should ask about symptoms between dialysis sessions and explore the possibility of hypotensive events in symptomatic patients.
Roberts
Russell G
RG
Renal Units, Freeman Hospital and Royal Victoria Infirmary, Newcastle upon Tyne, UK. russell.roberts@bradfordhospitals.nhs.uk
Kenny
Rose Anne
RA
Brierley
Elizabeth J
EJ
D000058:Accidental Falls / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology* / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology