title: Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis.
abstract: BACKGROUND
  Although frailty has been linked to higher risk of falls and fracture in the general population, only few studies have examined the extent to which frailty is associated with these outcomes among patients with end-stage renal disease, who are at particularly high risk for these events.
  
  
  METHODS
  A total of 1,646 patients who were beginning maintenance hemodialysis in 297 dialysis units throughout the United States from September 2005 to June 2007 were enrolled in the Comprehensive Dialysis Study, and 1,053 Medicare beneficiaries were included in this study. Self-reported frailty was defined by the patients endorsing 2 or more of the following: poor physical functioning, exhaustion or low physical activity. Falls and fractures requiring medical attention were identified through Medicare claims data. We examined the association between frailty and the time to first fall or fracture using the Fine-Gray modification of Cox proportional hazards regression, adjusted for demographics, Quételet's body mass index, diabetes mellitus, heart failure and atherosclerosis.
  
  
  RESULTS
  Seventy-seven percent of patients were frail by self-report. The median length of follow-up was 2.5 (1.0-3.9) years. Crude rates of first medically urgent falls or fractures were 66 and 126 per 1,000 person-years in non-frail and self-reported frail participants, respectively. After accounting for demographic factors, comorbidities and the competing risk of death, self-reported frailty was associated with a higher risk of falls or fractures requiring medical attention (hazards ratio 1.60, 95% CI 1.16-2.20).
  
  
  CONCLUSIONS
  Participants reporting frailty experienced nearly twice the risk of medically urgent falls or fractures compared to those who did not report frailty.
authors.affiliation: Nephrology Section, San Francisco VA Medical Center, and Division of Nephrology, University of California, San Francisco, Calif., USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Delgado
authors.forename: Stephanie
authors.initials: S
authors.lastname: Shieh
authors.forename: Barbara
authors.initials: B
authors.lastname: Grimes
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Lorien S
authors.initials: LS
authors.lastname: Dalrymple
authors.forename: George A
authors.initials: GA
authors.lastname: Kaysen
authors.forename: John
authors.initials: J
authors.lastname: Kornak
authors.forename: Kirsten L
authors.initials: KL
authors.lastname: Johansen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D057566:Self Report; D014481:United States / Q000453:epidemiology