Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study

Abstract

This study examined whether chronic kidney disease (CKD) is associated with recurrent falls in older adults in nursing homes (NHs). We used data abstracted over a six month period from 510 NH residents with a history of falls. Thirty-five percent of the NH residents had CKD. In adjusted analyses, the incidence of recurrent falls was similar in those with and without CKD [fall rate ratio (FRR) 1.00, 95% confidence interval (CI) 0.97-1.02]. Orthostatic hypotension (FRR 1.52, 95% CI 1.12-2.05), history of falls during the prior six month period (FRR 1.25, 95% CI 1.05-1.49), cane or walker use (FRR 1.64, 95% CI 1.16-2.33), and ambulatory dysfunction (FRR 1.47, 95% CI 1.23-1.75) were independently associated with increased fall rate. CKD was not an important predictor of falls in this cohort of nursing home residents with prior falls. Instead, traditional fall risk factors were much more strongly associated with recurrent falls.

Keywords: Frail elderly; Renal insufficiency; Skilled nursing facility.

Figure 1

Median Fall Rate by Estimated Glomerular Filtration Rate Category Abbreviations: eGFR = estimated glomerular filtration rate. The cohort's unadjusted median fall rate per 100 patient-days divided into three categories: eGFR > 60ml/min/1.73m², eGFR ≥ 45 and <60ml/min/1.73m² and eGFR <45ml/min/1.73m².

Figure 2

Estimated Glomerular Filtration Rate Interaction with Age Threshold of 80 Years Abbreviations: eGFR = estimated glomerular filtration rate. Solid line indicates age over 80 years. Dotted line indicates age under 80 years.