Association of intradialytic hypotension and physical performance with fall and fracture incidence in hemodialysis patients: The REPnet-HD study.

Abstract

Although hypotension has been linked to fall-related injuries in older adults, evidence in hemodialysis (HD) patients remains limited. This study examined the effects of intradialytic hypotension (IDH) and physical performance on the risk of subsequent falls and fractures. In this prospective cohort study, 518 ambulatory HD patients were observed over 1 year to track the occurrence of accidental falls, severe falls (those requiring medical intervention), and fractures. Baseline assessments included IDH (defined as nadir systolic blood pressure [BP] during dialysis <90 mmHg or intervention for hypotensive events [Nadir SBP90 + intervention]), nadir diastolic BP <50 mmHg (Nadir DBP50), and physical dysfunction. While IDH was not associated with overall falls, physical dysfunction was (odds ratio 2.10 [1.27, 3.45], P = 0.004). However, physical dysfunction was not independently linked to severe falls or fractures. Both Nadir SBP90 + intervention and Nadir DBP50 were associated with increased risks of severe falls (hazard ratio [HR] 3.84 [1.90, 7.75], P < 0.001; 2.56 [1.23, 5.35], P = 0.01, respectively) and fractures (HR 3.57 [1.52, 8.42], P = 0.003; 2.70 [1.15, 6.35], P = 0.02, respectively). Additionally, falls occurring after HD were more frequently associated with severe falls and fractures (post-HD 39.1%, pre-HD 15.4%, non-HD day 13.3%, night 8.3%; P = 0.02). The inclusion of Nadir SBP90 + intervention in prediction models improved severe fall risk discrimination (Δ area under the curve 0.05, P = 0.04). These findings emphasize the need to address cardiovascular mechanisms regulating BP during dialysis to mitigate fall-related injuries.