Accidental Falls and Risk of Mortality among Older Adults on Chronic Peritoneal Dialysis

Abstract

Background and objectives 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.Design, setting, participants, & measurements 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.

Equivalent Fall Risk in Elderly Patients on Hemodialysis and Peritoneal Dialysis

“…Falls in the elderly population are associated with increased hospitalization, need for long-term care, and mortality (4,8,12,16,28). Other consequences include fear of falling, resulting in physical activity restriction, functional decline, and frailty (29).…”

“…The study protocol has previously been described in detail (8,12). Briefly, all end-stage renal disease patients 65 years and over undergoing chronic dialysis treatment during the period April 9, 2002, to April 9, 2003, at the University Health Network were approached to participate in the study.…”

Risk of falls in chronic kidney disease

“…Moreover, they have a three to four times greater risk for hip fractures compared to the general population 8,9 . The morbidity and mortality are higher in the hemodialysis population 6 and in peritoneal dialysis patients as well 10 .…”

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

“…Studies have shown that the incidence of falls in HD patients is about 1.2-1.6 per patient-year, or 0.2-0.37 per patient-year for patients with severe conditions requiring emergency care (20)(21)(22). A recent prospective cohort study showed that the incidence of falls may increase to 1.7 per patient-year for older PD patients (23). To our knowledge, no study has directly compared the risk of falls between PD and HD patients.…”