NDT Advance Access originally published online on December 5, 2007
Nephrology Dialysis Transplantation 2008 23(4):1396-1400; doi:10.1093/ndt/gfm778
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Geriatric comorbidities, such as falls, confer an independent mortality risk to elderly dialysis patients
1 Department of Medicine 2 Division of Clinical Decision-making & Health Care, Toronto General Research Institute, University of Toronto, Toronto, Ontario 3 Division of Geriatric Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
S. V. Jassal, University of Toronto and University Health Network, 8NU-857, 200 Elizabeth St, Toronto, M5G 2C4, Canada. Tel: +1-416-340-3196; Fax: +1-416-340-4999; E-mail: vanita.jassal{at}uhn.on.ca
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Abstract |
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Background. As the number of patients aged 
65 years starting haemodialysis (HD) continues to increase, more patients are at risk of falls, functional decline and cognitive impairment. In an earlier prospective cohort study, we showed that 44% of elderly HD patients had more than one fall within a 1-year period. The objective of this study was to assess whether falls remained predictive of increased mortality risk even after controlling for age, comorbidity, dialysis vintage and laboratory variables.
Methods. Using a prospective, cohort study design, patients aged 65 years and on chronic HD during the period April 2002–2003 were recruited. Patients were followed biweekly, and falls occurring within the first year were recorded. Outcome data were collected until death, study end (30 December 2006), transplantation or transfer to another dialysis centre.
Results. A total of 162 patients were followed for a median of 32.7 months (quartiles 14–57). In a univariate Cox model with a time-dependent variable for falls status, survival was worse amongst fallers compared to non-fallers (HR 2.13, 95% CI 1.32–3.45; P = 0.002). After adjustment for age, dialysis vintage, comorbidity and laboratory variables, falls were a significant predictor of mortality (HR 1.78, 95% CI 1.07–2.98, P = 0.03). Exclusion of falls associated with concurrent illnesses did not alter the results (HR 1.63, CI 1.02–2.28 P = 0.05).
Conclusions. We conclude that the occurrence of more than one accidental fall in a community-dwelling HD patient aged 65 years is associated with an independent increased risk of death. As fall interventions are effective, screening HD patients for falls may be a simple measure of clinical importance.
Keywords: accidental falls; geriatric nephrology; haemodialysis; mortality; predictive model
Received for publication: 8. 8.07
Accepted in revised form: 4.10.07