Incidence and predictors of falls in hemodialysis patients: a prospective cohort study comparing the Downton scale and the Index of Frailty-VIG

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People undergoing hemodialysis (HD) experience falls with a high incidence and frequency, which has an important impact on morbidity, quality of life, and the use of healthcare resources. Therefore, the early identification of risk factors and adequate screening tools are key for developing efficient prevention strategies. The aim was to estimate the incidence of falls among people undergoing dialysis and to analyze the associated factors, as well as to assess the performance of the Downton scale on the identification of fall risk, and to compare it with the Index of Frailty-VIG (IF-VIG). A prospective observational cohort study with a 12-month follow-up was conducted on 102 hemodialysis patients. A baseline assessment was performed of the clinical, pharmacological, functional, and social factors. The fall events that occurred during the follow-up period were recorded. A descriptive and analytical analysis was performed, using the chi-square test for the bivariate analysis, a multivariate analysis to identify associated factors, and ROC curves to evaluate the discriminatory ability of the screening tools. A total of 102 patients undergoing hemodialysis were included (mean age 72.3 ± 11.6 years; 70.6% men; mean time under hemodialysis 2.8 ± 3.2 years). During the 12-month follow-up, an incidence rate of 1.45 falls per patient-year was observed, as well as an accumulated incidence of 40.2%. Most of the falls occurred at home and on days without a hemodialysis session. Frailty, a longer period of time under hemodialysis, a history of falls, the use of central nervous system depressant drugs, and beta-blockers, as well as social vulnerability, were associated with the occurrence of falls. The IF-VIG showed a higher discriminatory capacity as compared to the Downton scale (AUC 0.696; p = 0.002 vs. AUC 0.571; p = 0.233). Falls during hemodialysis are frequent, occur mostly at home, and are associated with a history of falls, a longer period under hemodialysis, and frailty. The Downton scale showed low discriminative capacity, while the IF-VIG showed modest discriminative capacity in this cohort. These results support a preventive approach centered on vulnerability that must include the home setting. Not applicable.

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