#1314 Nutritional status: the silent risk of falls in hemodialysis patients

Abstract Background and Aims Hemodialysis patients are at an increased risk of falls, a significant health concern that can lead to serious injuries and reduced quality of life. Several factors contribute to this elevated risk including impaired balance, muscle weakness, and cognitive dysfunction. Nutritional status is increasingly being recognized as a critical factor influencing fall risk in this population. Malnutrition, protein-energy wasting, and micronutrient deficiencies are prevalent in haemodialysis population and can exacerbate their existing fall risk factors. This study will assess the complex interplay between nutritional status and fall risk in the hemodialysis population, exploring the possible underlying mechanisms. It will also investigate other potential risk factors of fall in this population. Method This is a prospective, single centre study, of patients on dialysis for at least 3 months, aged over 18. The study included a total of 68 patients. The patients were followed up for a period of 2 years and were tracked for the occurrence of fall either at home or at our institution. The nutritional status was assessed biannually by the clinical dieticians of the centre. Protein–energy wasting (PEW) was evaluated with anthropometric measurements, including Body Mass Index (BMI) and weight changes over 3 and 6 months. Functional muscle assessment included handgrip strength. It was also supported by a Nutrition Focused Physical Exam (NFPE) to evaluate the muscle loss severity. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria; incorporating weight loss, dietary intake, and muscle mass. Serum albumin levels were recorded at each evaluation. We also collected data from the patient's files that included baseline characteristics, demographic parameters, biochemical markers, hemodialysis parameters, presence of orthostatic hypotension or vision problems and anti-hypertensive medications. We also recorded the ambulatory status of the patient and their mean of transportation to the centre (alone/accompanied). Statistical analysis was performed using IBM SPSS Statistics software, version 22.0. Student's t-test, the Mann-Whitney U test, and chi-square tests were used at the bivariate level, and logistic regressions were done for multivariate analysis. Results The studied population consisted of 68 patients. The mean age (±SD) was 66.5 ± 13.3 years. The mean BMI was 26 ± 5.65 kg/m2. A total of 48.5 % of the patients were female. 38.2% of the patients experienced fall, and of these 46% had fallen once, 46% had fallen twice and 8% had fallen three times. In the bivariate analysis the risk of fall was significantly associated with the age of the patients (P = 0.003), the age at onset of dialysis (P = 0.009), serum albumin levels (P < 0.001) and potassium levels (P = 0.001), muscle loss severity (NFPE) (P = 0.057), the mode of transportation (P = 0.019), the ambulation status (P = 0.001) and the presence of orthostatic hypotension (P = 0.008). Logistic regression analyses’ results showed that muscle loss severity (NFPE) (P = 0.020), albumin levels (P = 0.015), potassium levels (P = 0.53), ambulation status (P = 0.001) and orthostatic hypotension (P = 0.035) were significantly associated with an increased risk of fall. Conclusion Our study revealed a significant contribution of nutritional compromise to fall risks in hemodialysis patients. It showed that the severity of muscle loss along with lower levels of serum albumin and potassium are strongly associated with falls. Additionally, assisted/dependent ambulation and orthostatic hypotension were independently associated with a higher incidence of falls. These findings provide insight into the risk factors associated with falls enabling the development of targeted fall prevention strategies. Further interventional studies are warranted to investigate the effect of nutritional interventions in reducing fall risk in this patient group. Figure 1: (A) Number of falls in the studied population.