Table 1.
Frequency and factors of falls in HD patients.
| Author, Year, Country | Design, Setting (Study Period) |
Age (Years) Male/Female |
Sample Size, Falls (First Fall) |
Fall Activities, Location | Fall Timing | Fall Risk Factors |
|---|---|---|---|---|---|---|
| Roberts RG et al., 2003 [19] UK | Cross-sectional study One hospital HD unit |
Mean 78.2 ± 5.3 Male 48.9% Female 51.1% |
n = 47 13 (27.7%) |
Not listed | Not listed | Postural hypotension ※No multivariate analysis |
| Desmet C et al., 2005 [28] Belgium | Prospective cohort study (8 weeks) Seven HD units |
Median 70.9 (25.3–92.8) Male 56.4% Female 43.6% |
n = 308 56 (12.7%) |
Home (82%), Public sites (7%), Other (9%), unknown (2%) | Five falls were recorded during the first 24 h after dialysis. Among the remaining 33 falls, 24 falls were observed within 22 h after HD therapy versus 9 falls within 22 h before HD therapy (p = 0.058). | Older age, diabetes, walking test failed, intake of an antidepressant, and high number of oral prescribed drugs |
| Cook WL et al., 2006 [18] Canada |
Prospective cohort study (12 months) One outpatient HD unit |
Mean 74.7 Male 57% Female 43% |
n = 169 305 (45.0%) |
Walking (69% indoors, 31% outdoors), standing from the seated position (31%), trying to rise from a lying position (12%). | Falls occurred with similar frequency on dialysis and non-dialysis days (p = 0.05). On dialysis days, falls were more common after dialysis (73%) than before (27%). |
Male gender, history of falls, low mean pre-dialysis systolic blood pressure, higher number of comorbidities |
| Roberts R et al., 2007 [30] UK | Prospective cohort study (6 months) One hospital HD unit |
Median 58 (52–83) Male 65.4% Female 34.6% |
n = 78 14 ・aged > 65: (38%) ・younger: (4%) |
Not listed | Not listed | Age ※No multivariate analysis |
| Li M et al., 2008 [20] Canada | Prospective cohort study (12 months) One hospital HD unit |
Mean 74.7 ± 6.1 Male 57.0% Female 43.0% |
n = 162 305 (46.9%) |
Not listed | Not listed | Older, higher number of comorbidities, diabetes, initiated renal replacement therapy more recently ※No multivariate analysis |
| Abdel-Rahman EM et al., 2010 [21] USA | Prospective cohort study (12 months) Two outpatient HD units |
Mean 62.4 ± 16.1 Male 61.8% Female 38.2% |
n = 76 20 (26.3%) |
Not listed | Not listed | Age ≥ 65 years, Female |
| McAdams-DeMarco MA et al., 2013 [32] USA | Prospective cohort study (6.7 months) One outpatient dialysis unit |
Mean 65 ± 12.6 Male 53.7% Female 46.3% |
n = 95 70 (28.3%) |
Not listed | Not listed | Frailty |
| Polinder-Bos HA et al., 2014 [22] Netherlands | Prospective cohort study (12 months) Two hospital HD units |
Median 79.3 (70–89) Male 52% Female 48% |
n = 49 40 (55.5%) |
Not listed | Not listed | Lower systolic blood pressure before dialysis, higher PTH |
| Farragher JF et al., 2016 [23] Canada |
Prospective cohort study (12 months) One hospital HD unit |
・HD Mean 74.7 ± 6.1 Male 57.0% Female 43.0% ・PD Mean 73.2 ± 9.0 Male 55.0% Female 45.0% |
・HD n = 162 305 (46.9%) ・PD n = 74 87 (54%) |
Not listed | Not listed | Male, number of comorbidities, ≥1 reported fall in previous year |
| Zanotto T. et al., 2018 [24] UK | Cross-sectional study Two hospital HD units |
Mean 61.1 ± 14 Male 53.9% Female 46.1% |
n = 72 80 (36.1%) |
Gait and balance issues (65.4%), environmental hazards (46.2%), and dizziness or syncope-like events (42.3%). |
Not listed | None of the variables were significantly associated with falling. |
| Kono K. et al., 2018 [33] Japan |
Prospective cohort study (2 years) Two outpatient dialysis units |
Mean 69.4 ± 11.6 Male 60% Female 40% |
n = 223 91(41%) |
Not listed | Not listed | Age of 80 years and older, high CRP level, decreasing GNRI, SPPB 8 points or less, decreasing grip, presence of intradialytic hypotension, high scores in the inquiry regarding falling |
| van Loon IN et al., 2019 [31] England and Northern Ireland | Prospective cohort study (24 months) Twenty-two outpatient HD units |
Mean 75.0 ± 7.0 Male 60.0% Female 40.0% |
n = 203 54 (47%) |
Not listed | Not listed | Diabetes mellitus, previous falls |
| Zanotto T. et al., 2020 [25] UK | Prospective cohort study (12 months) Three outpatient HD units |
Mean 61.8 ± 13.4 Male 54.4% Female 45.6% |
n = 68 25 (36.8%) |
Not listed | Not listed | Higher center of pressure range in medial–lateral direction during eyes closed |
| Zanotto T et al., 2020 [26] UK | Prospective cohort study (12 months) Three hospital HD units |
Mean 61.7 ± 13.3 Male 55.1% Female 44.9% |
n = 69 80 (37.7%) |
Walking (31%), getting up (21%), turning around (15%), using stairs (6%), other (26%). Home (72%), outdoors (19%), public site (9%). |
Not listed | Worse baroreflex function, orthostatic decrements of blood pressure to 60° head-up tilt test |
| Chu NM et al., 2020 [27] USA | Prospective cohort study (108 months) Two hospital HD units |
・Kidney transplantation donors Mean 54.0 ± 14.0 Male 61.9% Female 38.1% ・Kidney transplantation recipients Mean 54.3 ± 14.0 Male 62.1% Female 37.9% |
・Kidney transplantation donors n = 3666 598 (16.3%) ・Kidney transplantation recipients n = 770 96 (12.5%) |
Not listed | Not listed | ・Kidney transplantation candidates: frailty, lower extremity impairment (SPPB score ≤ 10), poor HRQOL ・Kidney transplantation recipients: frailty, lower extremity impairment (SPPB score ≤ 10) |
HD, hemodialysis; PTH, parathyroid hormone; PD, peritoneal dialysis; CRP, C-reactive protein; GNRI, geriatric nutritional risk index; SPPB, Short Physical Performance Battery; HRQOL, health-related quality of life.