#2870 Association between frailty and a history of falls in patients on hemodialysis
Authors: Reboredo Maycon Moura , Bainha Ana Clara , Lucinda Leda Marília Fonseca , de Jesus Luciana Angélica Da Silva , Queiroz Gabrielle Gomes , Pires Luis Felipe Petronilho , Da Silva Mauro José França João , Carvalho César Contin , Drumond Lorrayne , Ribeiro Maria Eduarda Martins , Pinheiro Bruno Valle , Segura-Orti Eva 
Published: May 2024

Abstract

Background and Aims
Patients with end-stage renal disease on hemodialysis have a higher prevalence of frailty that is associated with relevant outcomes such as disability, hospitalization, and mortality. Moreover, these patients have musculoskeletal and physical function impairments that contribute to a higher risk of falling. Therefore, the aim of this study was to evaluate the association between frailty and a history of falls in patients on hemodialysis.

Method
This cross-section multicenter study included patients aged ≥18 years who were undergoing regular hemodialysis treatment for at least three months. Patients were excluded if presented severe and unstable comorbidities, psychiatric or cognitive disorders, and physical limitations including neurological, musculoskeletal and osteoarticular diseases which prevented the correct execution of the physical function tests. Frailty was assessed by Fried phenotype and the criteria were as follows: unintentional weight loss ≥ 4.5 kg in the past year; exhaustion was assessed using the vitality domain of the SF-36 quality of life questionnaire; weakness was measured using a handgrip dynamometer; walking speed was assessed by timing the 4.6 m distance covered at the participant's normal pace; and physical activity level was measured by the Human Activity Profile questionnaire. Patients were stratified into three groups: a score of 0/5 for non-frail, a score of 1-2/5 for pre-frail, and a score of 3-5/5 for frail. The retrospective history of falls was assessed for the last 12 months, and a fall was defined as an “unexpected event in which the individual comes to rest on the ground, floor or lower level”. The association between frailty stratification and a history of falls was analyzed using multivariate multinomial logistic regression model with non-frail group as reference. Then, a model adjusted for potential confounders was constructed.

Results
This study included 199 patients (59.1 ± 12.5 years, 41.2% female). The prevalences of frailty and pre-frailty were 17.6% and 54.8%, respectively. Patients classified as non-frail showed lower prevalence of a history of falls compared to patients classified as pre-frail and frail (26%, 36% and 54%, respectively, p &lt; 0.001). The absence of a history of falls decreased the chance of patients being classified as frail (OR = 0.23, 95% CI = 0.07-0.78, p = 0.018). After adjusting for age, educational level, time on dialysis, hemoglobin and presence of cardiovascular disease, this association remained significant (OR = 0.16, 95% CI = 0.04-0.57, p = 0.005).

Conclusion
The prevalence of pre-frailty was approximately three times higher than that of frailty in patients on hemodialysis. A history of falls was associated with frailty in these patients.