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. 2014 Jun;7(3):257-63.
doi: 10.1093/ckj/sfu034. Epub 2014 Apr 15.

Falls among hemodialysis patients: potential opportunities for prevention?

Nancy G Kutner  1 , Rebecca Zhang  1 , Yijian Huang  1 , Haimanot Wasse  2
Affiliations

Falls among hemodialysis patients: potential opportunities for prevention?

Nancy G Kutner et al. Clin Kidney J. 2014 Jun.

Abstract

Background: Falls among patients undergoing maintenance hemodialysis (HD) have significant consequences for quality of life and functional independence, morbidity, healthcare utilization and even mortality, but studies on the etiology of falls within large HD cohorts are limited.

Methods: Falls during the past 12 months were ascertained for a prevalent multi-center HD cohort (n = 762) aged 20-92 years, and associations with demographic and treatment characteristics, comorbidities, cognitive function, prescribed medications, balance tests, frailty and depressive symptoms were assessed.

Results: Falls were sustained by 28.4% of participants. In multivariable-adjusted analyses, participants classified as frail were over two times more likely to report falls [odds ratio (OR): 2.39, 95% confidence interval (CI): 1.22-4.71, P = 0.01], and participants with a CES-D score 18+ and/or prescribed antidepressants were over 80% more likely to be fallers (OR: 1.83, 95% CI: 1.23-2.74, P = 0.003) than were participants with a CES-D score <18 and no prescribed antidepressants.

Conclusions: Frailty and depressed mood, factors that are potentially modifiable, are prominently associated with falls.

Keywords: USRDS; depression; falls; frailty; hemodialysis.

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Figures

Fig. 1.
Fig. 1.
Percentage of participants who reported falls, by CES-D score 18+/<18 and prescribed/no prescribed antidepressant(s). Participants in the three elevated CES-D score and/or prescribed antidepressant categories, compared with the reference category of non-elevated CES-D score and no prescribed antidepressants, were over 80% more likely to be fallers (OR: 1.83, 95% CI 1.23–2.74, P = 0.003).
Fig. 2.
Fig. 2.
Percentage of participants who reported falls, by types of antidepressant medication prescription and no antidepressant medication prescription. Examples of participants' prescribed SSRIs include escitalopram, fluoxetine, sertraline and paroxetine. Examples of participants' prescribed atypical antidepressants include bupropion, mirtazapine, trazodone and venlafaxine. Examples of participants' prescribed tricyclic antidepressants include amitriptyline, doxepin and nortriptyline. Twenty-eight percent of patients for whom an SSRI was prescribed were also prescribed a medication in another antidepressant category.
Fig. 3.
Fig. 3.
Fall rates by age category of study participants.
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