Falls in hemodialysis patients: Prospective study of incidence, risk factors, and complications
Falls in hemodialysis patients: Prospective study of incidence, risk factors, and complications
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DOI：
10.1053/j.ajkd.2004.09.027
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发表时间：
2005-01-01
影响因子：
13.2
通讯作者：
Jadoul, M
中科院分区：
文献类型：
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作者：
Desmet, C;Beguin, C;Jadoul, M
。背景：跌倒在老年非尿毒症患者中很常见，并且与不良预后相关。最近的国际指南建议对跌倒者和有跌倒风险的人进行适当评估，以实施多维预防策略。令人惊讶的是，尽管全世界接受血液透析 (HD) 治疗的老年患者数量不断增加，但血液透析 (HD) 患者跌倒的发生率、危险因素和并发症尚不清楚。方法：我们联系了来自 7 个比利时中心 HD 单位的所有患者。 2001 年 3 月，对同意的患者进行了评估，以确定是否存在失败的危险因素（人口统计、选定的合并症、步态/平衡测试、主要生化标志物以及药物和 HD 治疗方案）。随后，自 2001 年 4 月 1 日起 8 周内，通过询问患者、亲属和护理人员，所有 7 个科室的工作人员记录了跌倒情况（包括情况和衍生的并发症）。跌倒后连续骨折的记录持续了 12 个月。结果：308 名患者同意参加（接受率 94%）。他们的中位年龄为 70.9 岁（56% 为男性，27% 患有糖尿病）。 39 名患者 (12.7%) 的中位年龄为 74.7 岁，在 8 周内至少跌倒一次（总共 56 次跌倒），平均跌倒发生率为 1.18 次/患者年。三分之一的跌倒造成损伤，需要医疗保健甚至住院治疗 (n = 6)。在 12 个月内，12 名患者 (3.9%) 经历了跌倒相关骨折。 Logistic 回归确定了年龄较大（比值比，1.057/年；P = 0.01）、糖尿病（比值比，2.747；P = 0.02）、大量处方口服药物（比值比，1.19/药物；P = 0.011）、抗抑郁药物的使用（比值比，5.263；P < 0.001）和无法行走10 m 无帮助（比值比，2.057；P = 0.001）作为失败的独立风险因素。结论：跌倒在中心 HD 患者中很常见。我们的逻辑模型描绘的高危人群似乎是干预研究的优先目标（包括运动计划和特别是某些药物的更有选择性的处方），以减少跌倒的发生率和并发症。 (C) 2004 年，国家肾脏基金会 (National Kidney Foundation, Inc.)
. Background: Falls are common in elderly nonuremic patients and are associated with poor outcomes. Recent international guidelines recommend proper assessment of fallers and those at risk for falling to implement multidimensional preventative strategies. Surprisingly, the incidence, risk factors, and complications of falls in hemodialysis (HD) patients are unknown despite the growing number of elderly patients on HD therapy worldwide. Methods: We contacted all patients from 7 Belgian in-center HD units. Consenting patients were evaluated in March 2001 for the presence of risk factors for failing (demographics, selected comorbid conditions, gait/balance tests, main biochemical markers, and drug and HD regimens). Falls (including circumstances and derived complications) subsequently were recorded by staff members of all 7 units for 8 weeks from April 1, 2001, through questioning of patients, relatives, and caregivers. Fractures consecutive to falls were recorded for 12 months. Results: Three hundred eight patients agreed to participate (acceptance rate, 94%). They had a median age of 70.9 years (56% men, 27% patients with diabetes). Thirty-nine patients (12.7%) with a median age of 74.7 years fell at least once during the 8 weeks (total, 56 falls), an average incidence of 1.18 fall/patient-year. One third of the falls caused lesions requiring health care or even hospitalization (n = 6). During 12 months, 12 patients (3.9%) experienced a fall-related fracture. Logistic regression identified older age (odds ratio, 1.057/y; P = 0.01), diabetes (odds ratio, 2.747; P = 0.02), high number of prescribed oral drugs (odds ratio, 1.19/drug; P = 0.011), antidepressant use (odds ratio, 5.263; P < 0.001), and failing to walk 10 m without help (odds ratio, 2.057; P = 0.001) as independent risk factors for failing. Conclusion: Falls are common in in-center HD patients. The high-risk population delineated by our logistic model appears as a priority target for intervention studies (including exercise programs and more selective prescription of some drugs in particular) to reduce the incidence and complications of falls. (C) 2004 by the National Kidney Foundation, Inc.