A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65�ml/min

Abstract

Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36 weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65 ml/min. Results: At baseline, serum levels of 1.25(OH) 2 D 3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D 3 were not associated with CrCl. Below a CrCl of 65 ml/min, 1.25(OH) 2 D 3 serum levels steadily declined. We therefore chose a CrCl of 65 ml/min as cutoff for further analyses. During the 36 weeks of observation, elderly people with a CrCl of <65 ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ‡65 ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/ 116; OR=3.68; 95% CI, 1.38-9.82; p=0.009). Conclusions: For the first time we showed that in a communitydwelling population of elderly men and women, a CrCl of less than 65 ml/min is a significant and independent risk factor for fallers and falls.

Diabetes-Related Complications, Glycemic Control, and Falls in Older Adults

“…Recent studies have reported that poor renal function is a risk factor for falls in older adults (23). We found a linear association between fall risk and cysC, suggesting that even modest declines in renal function are a risk factor for falls.…”

Avaliação da capacidade da Escala Internacional de Eficácia de Quedas em discriminar risco de quedas em pacientes com doença renal crônica submetidos à hemodiálise

“…Although a study by Boudville et al 20 , and this study did not find association between PTH levels and falling, some researchers observed that higher PTH levels are related to the latter 27,28 , considering that bone fragility, muscle weakness, and poor postural balance are independent risk factors for the occurrence of falls and fractures 29 . Therefore, high PTH levels associated with low vitamin D levels in individuals on hemodialysis cause a negative impact on muscle strength and functional mobility, because they cause the atrophy of muscle fibers of rapid concentration, thus predisposing the individuals to falling 11 . The fact that no association was found suggests the necessity of studies that investigate this occurrence.…”

“…Studies report the association among creatinine clearance, a decrease in the serum levels of calcitriol, and vitamin D receptors in the muscle with an increase in the risk of falling [7][8][9] . The low levels of calcitriol associated with high levels of PTH are related to myopathy, loss of balance, the occurrence and medical history of falls [10][11][12] , and due to the latter, the decline of physical functioning 13 . Therefore, recognizing the importance of evaluating the fear of falling in patients with CKD, this study aimed at assessing the capacity of the FES-I, the serum levels of PTH, and the length of time on hemodialysis treatment (LTH) in discerning falling from non-falling patients with CKD under hemodialysis treatment.…”

Dialysis in Late Life

“…in age-matched populations (15)(16)(17) and have an overall lower level of independent functioning (18 -20) and increased burden of cognitive impairment (21)(22)(23). Fall incidence rates have been estimated between 1.2 to 1.6 falls per person-year for dialysis patients whoa re older than 65 yr (16,23).…”