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Association of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults.

TitleAssociation of Reduced eGFR and Albuminuria with Serious Fall Injuries among Older Adults.
Publication TypeJournal Article
Year of Publication2016
AuthorsC Bowling, B, Bromfield, SG, Colantonio, LD, Gutiérrez, OM, Shimbo, D, Reynolds, K, Wright, NC, Curtis, JR, Judd, SE, Franch, H, Warnock, DG, McClellan, W, Muntner, P
JournalClin J Am Soc Nephrol
Date Published2016 07 07
KeywordsAccidental Falls, Administrative Claims, Healthcare, Aged, Aged, 80 and over, Albuminuria, Brain Injuries, Creatinine, Female, Follow-Up Studies, Fractures, Bone, Glomerular Filtration Rate, Humans, Incidence, Joint Dislocations, Male, Medicare, Prospective Studies, Renal Dialysis, Renal Insufficiency, Chronic, United States, Wounds and Injuries

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 (eGFR<60 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 ≥60, 45-59, and <45 ml/min per 1.73 m(2), 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 m(2), respectively, versus eGFR≥60 ml/min per 1.73 m(2) 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 ACR<30 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.

Alternate JournalClin J Am Soc Nephrol
PubMed ID27091516
PubMed Central IDPMC4934847
Grant ListK12 HS023009 / HS / AHRQ HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
IK2 CX000856 / CX / CSRD VA / United States
R03 AG042336 / AG / NIA NIH HHS / United States
K24 HL125704 / HL / NHLBI NIH HHS / United States