TOPLINE

Among patients undergoing haemodialysis, falls were common, occurred mostly at home, and were associated with a history of falls, a longer duration on haemodialysis, the use of certain medications, and frailty. A frailty index showed better discriminative performance for predicting falls than a traditional fall risk assessment scale.

METHODOLOGY: 

• Researchers conducted a prospective cohort study to examine the incidence of falls, their predisposing factors, and consequences in patients undergoing haemodialysis, and to compare the discriminative performance of the traditional Downton fall scale with that of the Index of Frailty-VIG (IF-VIG), a multidimensional frailty index derived from comprehensive geriatric assessment, in identifying the risk for falls.
• They included 102 patients undergoing haemodialysis (mean age, 72.31 years; 70.6% men; mean time on dialysis, 2.8 years), with 75 completing the 12-month follow-up. Bedridden patients, those with acute pathology, and those who were totally dependent or needed full assistance for transfers were excluded.
• The primary outcome was the occurrence of falls during the 12-month follow-up period. A fall was defined as any event in which the participant unintentionally came to rest on the ground or a lower level.
• Falls were actively monitored, with patients asked about new events at every session and families or caregivers involved when communication was a concern. Details of each fall were collected through a structured interview.
• Frailty was measured using the IF-VIG, and the risk for falls was assessed using the Downton scale. Additional domains, including cognitive function, activities of daily living, socio-family risk, quality of life, and fear of falling, were assessed using appropriate scales.

TAKEAWAY

• During the follow-up period, 41 patients experienced a total of 70 falls; overall, 40.2% of the patients had at least one fall, and 16.7% experienced recurrent falls (two or more events); the overall incidence rate was 1.45 falls per patient-year.
• Nearly three quarters of the falls occurred at home, and about half of all events took place on days when patients did not have a scheduled haemodialysis session.
• Greater frailty, a longer period of time under haemodialysis, a history of falls, the use of central nervous system depressant drugs, and the use of beta-blockers were associated with the occurrence of falls. A history of falls (adjusted odds ratio [aOR], 7.13; P = .003) and a longer duration on haemodialysis (aOR, 1.32 per year; P = .005) were independently associated with increased odds of falling.
• IF-VIG outperformed the Downton scale in terms of discriminative capacity (area under the curve, 0.696 vs 0.571; P = .002 vs .233), with higher sensitivity and specificity at their respective clinical thresholds.

IN PRACTICE

"The results support the implementation of a structured preventative approach in HD [haemodialysis] units that includes the systematic identification of a history of falls as a high-risk marker, the periodical assessment of risk as a function of the amount of accumulated time under dialysis, and the routine screening of frailty as an indicator of underlying vulnerability," the authors wrote.

SOURCE

This study was led by Anabel Ramírez-García, Consorci Sanitari de l'Anoia, Igualada, Spain. It was published online on September 05, 2026, in BMC Nephrology.

LIMITATIONS

The study was limited by its sample size and single-centre design. Data were missing for some variables, particularly those related to frailty and functional assessment. In addition, certain potentially relevant risk factors for falls, such as intradialytic hypotension, dialysis adequacy, haemodynamic variables, and objective physical function measures, were not assessed.

DISCLOSURES

This study was supported by the Agency for Management of University and Research Grants, Generalitat de Catalunya, Spain, through the Industrial Doctorate Programme. The authors declared no relevant competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.