Calf Circumference Predicts Falls in Older Adults on Hemodialysis

Abstract

Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. This is a prospective study that enrolled patients aged ≥65years on conventional hemodialysis, followed for 6months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34cm for men and <33cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). Ninety-one patients were included (age 73.7±5.4years, 69.2% men, 56% with diabetes). Mean CC was 32.6±3.7cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P=.017 and P=.025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P=.037), higher age (HR 1.19, CI: 1.04-1.36, P=.011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P=.003) were independently associated with falls in a fully adjusted model. CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.