Abstract

Background and objectives Falls are common and associated with adverse outcomes in patients on dialysis. Limited data are available in earlier stages of CKD. Design, setting, participants, measurements We analyzed data from 8744 Reasons for Geographic and Racial Differences in Stroke Study participants. >= 65 years old with Medicare fee for service coverage. Serious fall injuries were defined as a fall-related fracture, brain injury, or joint dislocation using Medicare claims. Hazard ratios (HRs) for serious fall injuries were calculated by eGFR and albumin-to-creatinine ratio (ACR). Among 2590 participants with CKD (eGFR60 ml/min per 1.73 m(2) or ACR >= 30 mg/g), cumulative mortality after a serious fall injury compared with age-matched controls without a fall injury was calculated. Results Overall, 1103 (12.6%) participants had a serious fall injury over 9.9 years of follow-up. The incidence rates per 1000 person-years of serious fall injuries were 21.7 (95% confidence interval [95% CI], 20.3 to 23.2), 26.6 (95% CI, 22.6 to 31.3), and 38.3 (95% CI, 31.2 to 47.0) at eGFR levels 45-59, and 45 ml/min per 1.73 m2, respectively, and 21.3 (95% CI, 20.0 to 22.8), 31.7 (95% CI, 27.5 to 36.5), and 42.2 (95% CI, 31.3 to 56.9) at ACR levels 30, 30-299, and >= 300 mg/g, respectively. Multivariable adjusted HRs for serious fall injuries were 0.91 (95% CI, 0.76 to 1.09) and 1.09 (95% CI, 0.86 to 1.37) for eGFR=45-59 and 45 ml/min per 1.73 m2, respectively, versus eGFR >= 60 ml/min per 1.73 m2 and 1.31 (95% CI, 1.11 to 1.54) and 1.81 (95% CI, 1.30 to 2.50) for ACR=30-299 and >= 300 mg/g, respectively, versus ACR30 mg/g. Among participants with CKD, cumulative 1-year mortality rates among patients with a serious fall and age-matched controls were 21.0% and 5.5%, respectively. Conclusions Elevated ACR but not lower eGFR was associated with serious fall injuries. Evaluation for fall risk factors and fall prevention strategies should be considered for older adults with elevated ACR.