Abstract
The association between serious falls and dialysis modality [hemodialysis (HD) and peritoneal dialysis (PD)] is unclear. A nationwide population-based retrospective cohort study with 127,823 end-stage renal disease patients aged over 18 years was conducted with the unmatched cohort of 101,304 HD and 7,584 PD patients retrieved from Taiwan’s National Health Insurance Research Database during 2000–2013. A total of 7,584 HD and 7,584 PD patients matched at 1:1 ratio by propensity score were enrolled to the study. Serious falls were defined by the diagnostic codes, E code, and image studies. Cox regression model and competing-risk model were used for statistical analysis. HD patients were older and had more comorbidities at baseline than PD patients. After matching and adjustment, HD patients had a higher risk of serious falls than PD patients [sHR 1.27 (95% CI 1.06–1.52)]. Females, elders, a history of falls before dialysis, comorbidity with stroke or visual problems, using diuretics, α-blockers, and mydriatics were associated with higher risks of serious falls among dialysis patients. The risk of serious falls was higher in HD patients than PD patients. Health professionals should create age-friendly environments, reduce unnecessary medications, and raise patients’ awareness of falls in daily life.
Highlights
HD patients (19.26%) were more likely to experience a history of falls before dialysis than peritoneal dialysis (PD) patients (11.7%)
HD patients had a higher risk of serious falls than PD patients in the Fine and Gray model, showing sub-distribution hazard ratio (sHR) 1.27
Our finding suggested that HD patients had worse baseline characteristics than PD patients before matching, including older age, more cardiovascular diseases (CVD) and comorbidities, and a history of more falls before dialysis; these baseline characteristics may lead to the consequences of higher crude incidence of serious falls and higher crude mortality rate
Summary
Previous studies have shown that the risk factors for falls in dialysis patients include old age[1,5,7,10], female[10], malnutrition[1], depression[1,10], cognitive dysfunction[1], a history of falls or stroke[1,11], low Body Mass Index (BMI)[10], frailty[8,12], post-dialysis fatigue[7], high comorbidity[5,10], psychotropic drug use and polypharmacy[1,13,14] as well as instability (hemodynamic and metabolic) caused by the dialysis therapy[2,7,15,16]. Some studies indicated that the risk of fall and hip fracture is higher in HD than in PD population[17,18,19], but some reported that the fall rates were similar between both groups[5,20]. We designed this nationwide population-based retrospective cohort study to estimate the risk of serious falls among HD and PD patients to determine which dialysis modality would be more associated with serious falls
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