Association between hemodialysis and fall risk in older adults with multiple diseases

Abstract Objectives: Falls are a major cause of morbidity and disability in older adults with multiple diseases. This study aimed to evaluate whether hemodialysis is related to fall risk in older adults with multiple diseases ,and to explore the effect of dialysis on falls was mediated through the ratio of Cr / CysC and activities of daily living (ADL).Methods: This retrospective study included patients aged ≥60 years-old with at least two comorbid diseases admitted to the Geriatric Nephrology Department of Jiangsu Province Hospital between December 2019 and June 2021. Clinical data were extracted from the medical records. Fall risk was evaluated with a modified Thomas scale. Results: The study included 91 patients in the non-hemodialysis group and 40 patients in the hemodialysis group. The hemodialysis group had lower activities of daily living (ADL) and higher body mass index/skeletal muscle index (SMI) ratio and modified Thomas score than the non-hemodialysis group. Linear regression revealed that older age (b= 0.07, 95% confidence interval [95%CI] = 0.06-0.09, P < 0.001) and hemodialysis (b= 0.67, 95%CI = 0.27-1.06, P = 0.001) were associated with higher fall risk. Hemodialysis exerted a significant direct effect on the modified Thomas fall risk score (b = 0.526, 95%CI = 0.432–1.433, P = 0.015) as well as a significant indirect effect via the Barthel index (b = 0.172, 95%CI = 0.010–0.333, P = 0.037)Conclusion: Hemodialysis increases the risk of falling in older adults with comorbidities. The effects of hemodialysis on fall risk were direct and indirect. Identifying inpatients on hemodialysis who are at risk of falling would facilitate targeted intervention strategies.