Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults.
Falls are common and associated with adverse outcomes in patients on dialysis. Limited data are available in earlier stages of CKD.



We analyzed data from 8744 Reasons for Geographic and Racial Differences in Stroke Study participants ≥65 years old with Medicare fee for service coverage. Serious fall injuries were defined as a fall-related fracture, brain injury, or joint dislocation using Medicare claims. Hazard ratios (HRs) for serious fall injuries were calculated by eGFR and albumin-to-creatinine ratio (ACR). Among 2590 participants with CKD (eGFR<60 ml/min per 1.73 m(2) or ACR≥30 mg/g), cumulative mortality after a serious fall injury compared with age-matched controls without a fall injury was calculated.



Overall, 1103 (12.6%) participants had a serious fall injury over 9.9 years of follow-up. The incidence rates per 1000 person-years of serious fall injuries were 21.7 (95% confidence interval [95% CI], 20.3 to 23.2), 26.6 (95% CI, 22.6 to 31.3), and 38.3 (95% CI, 31.2 to 47.0) at eGFR levels ≥60, 45-59, and <45 ml/min per 1.73 m(2), respectively, and 21.3 (95% CI, 20.0 to 22.8), 31.7 (95% CI, 27.5 to 36.5), and 42.2 (95% CI, 31.3 to 56.9) at ACR levels <30, 30-299, and ≥300 mg/g, respectively. Multivariable adjusted HRs for serious fall injuries were 0.91 (95% CI, 0.76 to 1.09) and 1.09 (95% CI, 0.86 to 1.37) for eGFR=45-59 and <45 ml/min per 1.73 m(2), respectively, versus eGFR≥60 ml/min per 1.73 m(2) and 1.31 (95% CI, 1.11 to 1.54) and 1.81 (95% CI, 1.30 to 2.50) for ACR=30-299 and ≥300 mg/g, respectively, versus ACR<30 mg/g. Among participants with CKD, cumulative 1-year mortality rates among patients with a serious fall and age-matched controls were 21.0% and 5.5%, respectively.



Elevated ACR but not lower eGFR was associated with serious fall injuries. Evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR.
Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Decatur, Georgia.|Departments of Medicine and.
C Barrett
CB
Bowling
Departments of Epidemiology.
Samantha G
SG
Bromfield
Departments of Epidemiology.
Lisandro D
LD
Colantonio
Departments of Epidemiology.|Medicine, and.
Orlando M
OM
Gutiérrez
Department of Medicine, Columbia University Medical Center, New York, New York; and.
Daichi
D
Shimbo
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California.
Kristi
K
Reynolds
Departments of Epidemiology.
Nicole C
NC
Wright
Departments of Epidemiology.|Medicine, and.
Jeffrey R
JR
Curtis
Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama.
Suzanne E
SE
Judd
Departments of Medicine and.
Harold
H
Franch
Medicine, and.
David G
DG
Warnock
Departments of Medicine and.
William
W
McClellan
Departments of Epidemiology.
Paul
P
Muntner
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000067575:Administrative Claims, Healthcare; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000652:urine*; D001930:Brain Injuries / Q000453:epidemiology; D003404:Creatinine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D004204:Joint Dislocations / Q000453:epidemiology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000401:mortality
D003404:Creatinine
Adult; Brain Injuries; CKD; Follow-Up Studies; Fractures, Bone; Humans; Renal Insufficiency, Chronic; albuminuria; falls; geriatric nephrology