Kidney function and other factors and their association with falls
Authors: Britting Sabine , Artzi-Medvedik Rada , Fabbietti Paolo , Tap Lisanne , Mattace-Raso Francesco , Corsonello Andrea , Lattanzio Fabrizia , Ärnlöv Johan , Carlsson Axel C. , Roller-Wirnsberger Regina , Wirnsberger Gerhard , Kostka Tomasz , Guligowska Agnieszka , Formiga Francesc , Moreno-Gonzalez Rafael , Gil Pedro , Martinez Sara Lainez , Kob Robert , Melzer Itshak , Freiberger Ellen ,   on behalf of the SCOPE investigators, Lattanzio Fabrizia , Corsonello Andrea , Bustacchini Silvia , Bolognini Silvia , D’Ascoli Paola , Moresi Raffaella , Di Stefano Giuseppina , Giammarchi Cinzia , Bonfigli Anna Rita , Galeazzi Roberta , Lenci Federica , Bella Stefano Della , Bordoni Enrico , Provinciali Mauro , Giacconi Robertina , Giuli Cinzia , Postacchini Demetrio , Garasto Sabrina , Cozza Annalisa , Guarasci Francesco , D’Alia Sonia , Firmani Romano , Nacciariti Moreno , Di Rosa Mirko , Fabbietti Paolo 
Published: October 2020

Abstract
Background
Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls.

Methods
The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving community-dwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment. The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUTS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects.

Results
Our series consisted of 2256 SCOPE participants (median age = 79.5 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment. CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79–1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81–1.28 for eGFR< 45; OR = 1.08, 95%CI = 0.74–1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67–1.24 for eGFR< 60; OR = 0.93, 95%CI = 0.63–1.37 for eGFR< 45; OR = 1.19, 95%CI = 0.62–2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 1.56, 95%CI = 1.29–1.89) and injurious falls (OR = 1.58, 95%CI = 1.14–2.19), and such associations were confirmed in all multivariable models.

Conclusions
Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes.

Trial registration
This study was registered on 25th February 2016 at clinicaltrials.gov (NCT02691546).