Accidental falls and risk of mortality among older adults on chronic peritoneal dialysis.
OBJECTIVE
More than 40% of elderly hemodialysis patients experience one or more accidental falls within a 1-year period. Such falls are associated with higher mortality. The objectives of this study were to assess whether falls are also common in elderly patients established on peritoneal dialysis and evaluate if patients with falls have a higher risk of mortality than patients who do not experience a fall.


METHODS
Using a prospective cohort study design, patients ages ≥ 65 years on chronic peritoneal dialysis from April 2002 to April 2003 at the University Health Network were recruited. Patients were followed biweekly, and falls occurring within the first 15 months were recorded. Outcome data were collected until death, study end (July 31, 2012), transplantation, or transfer to another dialysis center.


RESULTS
Seventy-four of seventy-six potential patients were recruited, assessed at baseline, and followed biweekly for falls; 40 of 74 (54%) peritoneal dialysis patients experienced 89 falls (adjusted mean fall rate, 1.7 falls per patient-year; 95% confidence interval, 1.0 to 2.7). Patients with falls were more likely to have had previous falls, be more recently initiated onto dialysis, be men, be older, and have higher comorbidity. Twenty-eight patients died during the follow-up period. After adjustment for known risk factors, each successive fall was associated with a 1.62-fold higher mortality (hazard ratio, 1.62; 95% confidence interval, 1.29 to 2.02; P<0.001).


CONCLUSIONS
Accidental falls are common in the peritoneal dialysis population and often go unrecognized. Falls were associated with higher mortality risk. Because fall interventions are effective in other populations, screening peritoneal dialysis patients for falls may be a simple measure of clinical importance.
Division of Nephrology, University Health Network, Toronto, Ontario, Canada;
Janine
J
Farragher
Division of Nephrology, University Health Network, Toronto, Ontario, Canada;
Ernest
E
Chiu
Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Division of Nephrology, Faculty of Medicine, Inonu University, Malatya, Turkey;
Ozkan
O
Ulutas
Department of Medicine, University Health Network and Mt. Sinai Hospital, Toronto, Ontario, Canada; and.
George
G
Tomlinson
Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Wendy L
WL
Cook
Division of Nephrology, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University Health Network and Mt. Sinai Hospital, Toronto, Ontario, Canada; and vanita.jassal@uhn.ca.
Sarbjit V
SV
Jassal
D000058:Accidental Falls / Q000401:mortality*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
dialysis; end stage kidney disease; geriatric nephrology; peritoneal dialysis