Falls in hemodialysis patients: prospective study of incidence, risk factors, and complications.
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.


CONCLUSIONS
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.
Desmet
Christine
C
Department of Medical Informatics, and Geriatrics, Cliniques Universitaires St Luc and Mont-Godinne, Université Catholique de Louvain, Brussels, Belgium.
Beguin
Claire
C
Swine
Christian
C
Jadoul
Michel
M
D000058:Accidental Falls / Q000401:mortality / Q000706:statistics & numerical data*; D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007022:Hypotension / Q000150:complications; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000451:nursing; D012307:Risk Factors; D012737:Sex Factors; D016138:Walking / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D001569:Benzodiazepines