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.

Keywords: dialysis; end stage kidney disease; geriatric nephrology; peritoneal dialysis.

Figure 1.

Study timeline and design.

Figure 2.

Box plot showing the distribution of BP readings is similar in both fallers and nonfallers. The whiskers extend to the largest or smallest nonoutlying value, where an outlier is defined to be 1.5× interquartile range above or below the limits of the box.

Figure 3.

Survival plot showing higher survival in patients who experienced no falls (black line) compared with those with one or more falls (gray line). Patients who reported a fall in 12 months before study recruitment were considered fallers at the start of the study. During the period of biweekly follow-up, participants could switch from the no falls group to the falls group if they experienced a fall. However, at the end of the fall follow-up period (15 months), participants remained within the group that they had been in until death or study end.