Fall Risk in Maintenance Hemodialysis Patients

Key Points Of the 643 patients undergoing long-term hemodialysis enrolled in a clinical trial for chronic pain, 28% experienced at least one fall, an incidence of 0.68 per participant year. Accidents were the most frequent cause of falls, and it was rare for them to be related to the hemodialysis procedure or occur at the hemodialysis unit. In multivariable analyses, demographic characteristics, severity of pain symptoms, or medication use such as opioids were associated with the fall risk. Background Falls are believed to be common in patients undergoing maintenance hemodialysis, but little is known about their frequency or outcomes. In this prospective study, we sought to increase our knowledge regarding the incidence, timing, circumstances, and outcomes of falls in this population. Methods Between January 2021 and April 2023, adults undergoing maintenance hemodialysis from 103 US dialysis facilities were enrolled in the Heart Outcomes Prevention Evaluation Consortium trial, which randomized participants with moderate or severe chronic pain to a pain coping skills, cognitive behavioral therapy intervention, or usual care. Occurrence of falls was a prespecified trial outcome. The research team inquired about falls at each 4-week follow-up visit during the 36-week study. Multivariable regression was used to explore associations of demographic and clinical characteristics, including patient-reported symptoms, with fall risk. Results Of 643 trial participants, 178 (28%) experienced 293 falls over a cumulative follow-up period of 429 participant-years for an overall rate of 0.68 falls per participant-year (95% confidence interval, 0.61 to 0.76). Accidents were the most frequent cause of falls (38%). It was rare for falls to be related to the hemodialysis treatment or to occur in the hemodialysis unit. Of the 293 falls, 36 (12%) were evaluated in the emergency department without subsequent hospitalization, 41 (14%) resulted in a hospital admission, and 19 (7%) led to a fracture. In multivariable analyses, demographic characteristics, severity of pain symptoms, or medication use such as opioids at enrollment were not associated with the fall risk. Conclusions Falls were common in this cohort of maintenance hemodialysis patients with chronic pain, occurring in 28% of individuals during a planned follow-up of 36 weeks. Falls rarely occurred in the dialysis unit, with the vast majority occurring at participants' homes and due to accidental causes. There was no significant association between patient-reported symptoms or medication use and the risk of subsequent falls. Clinical Trial registry name and registration number: ClinicalTrials.gov, NCT04571619.