SAT-031 DIFFICULTY IN ADL AND FALLS IN HEMODIALYSIS PATIENTS IN COMPARISON WITH NON-RENAL PATIENTS

Abstract

Patients undergoing hemodialysis have impaired activity of daily living (ADL), but it is not well characterized what activities are particularly difficult for such patients. In addition, hemodialysis patients have a high incidence of falls, although no previous study examined comparison with other population. The aims of this study were 1) to characterize the subjective difficulty in ADL, 2) to examine history of falls, and 3) to explore a possible relationship between ADL difficulty and falls in hemodialysis patients by comparing with those without renal failure. This was a cross-sectional study including two groups of out-patients in a single hospital aged 50 years or older. One was renal failure patients treated with maintenance hemodialysis, and the other was non-renal patients with diabetes mellitus, hypertension, and/or dyslipidemia (control group). ADL difficulty was evaluated by a questionnaire regarding a total of 48 items which were classified into the six categories of ADL namely locomotion, eating, toileting, dressing, bathing, and grooming. These items were rated by each participant as very easy (0), relatively easy (1), relatively difficult (2), or very difficult (3). Falls in the previous year was examined by a questionnaire. The participants were 209 hemodialysis patients (median age of 68, 42% women), 139 patients in the control group (median age of 67, 37% women). The median (interquartile range) of the total score of ADL difficulty was 10 (2 to 39) in the hemodialysis group, which was significantly higher than 2 (0 to 10) of the control group. The higher ADL difficulty in the hemodialysis group was again significant when the score was compared in the six categories. The proportion of those with history of falls in a year was 35% in the hemodialysis group, which was significantly higher than 12% in the control group. We examined factors associated with falls by using multivariate logistic regression analysis. Higher age and female sex were significant factors associated with falls in the control group, but not in the hemodialysis group. Of note, a higher total score of ADL difficulty was an independent factor associated with falls in both groups, and the same was true when the scores of the six ADL categories were individually analyzed. As compared with the control group, patients undergoing hemodialysis had a significantly higher difficulty in various ADLs, which could be attributable to both lower and upper limbs. They had history of falls at a higher proportion. The history of falls was shown to be associated with ADL difficulty commonly in the hemodialysis and control groups.