Fall Risk in Maintenance Hemodialysis Patients: A Secondary Analysis of the HOPE Consortium Trial
Abstract
BACKGROUND
Falls are thought 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 U.S. dialysis facilities were enrolled in the HOPE 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 pre-specified trial outcome. The research team inquired about falls at each four-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% CI: 0.61, 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,…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 643 participants or records.
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