Are elderly haemodialysis patients at risk of falls and postural hypotension?


Background:The numbers of older people on haemodialysis isrising. As aging and renal failure are riskfactors for autonomic failure and haemodialysisinvolves significant fluid shifts wehypothesized that older patients would besusceptible to hypotensive events betweendialysis sessions. Postural hypotension is arisk factor for falls. Falls are debilitatingand a leading cause of morbidity and mortalityin the elderly.Aim:To investigate whether postural hypotension andsymptoms of hypotension and falls are common inolder haemodialysis patients.Methods:All 47 patients from a single unit aged 70 orover were asked about falls in the previousyear and about symptoms that could be due tohypotension (syncope, presyncope, dizziness)between dialysis sessions. Twenty-threepatients underwent pre-and post-dialysisorthostatic blood pressure measurement, 18 had44 hour ambulatory blood pressure recording and10 subjects had full autonomic functiontesting.Results:Of 47 patients interviewed, 20 reportedsyncope/pre-syncope, 34 reported dizziness and14 recalled at least one fall in the previousyear. 8/23 had orthostatic hypotensionpre-dialysis and 16/23 post-dialysis. Mean44-hour blood pressure was 134/68 (±21/9) with no nocturnal dip. Autonomic functionwas abnormal in all 10 subjects tested.Conclusions:Elderly haemodialysis patients have a highincidence of hypotensive symptoms betweendialysis sessions, recalled falls in theprevious year and significant posturalhypotension post-dialysis. Physicianssupervising elderly haemodialysis patientsshould ask about symptoms between dialysissessions and explore the possibility ofhypotensive events in symptomatic patients.

This is a preview of subscription content, access via your institution.


  1. 1.

    UK Renal Registry Report 1999. Ansell D, Feest T, eds. Bristol, UK: UK Renal Registry.

    Google Scholar 

  2. 2.

    Harnett JD, Parfrey PS. Left ventricular dysfunction in dialysis subjects. In: Henrich E, ed. Principles and Practices of Dialysis. Baltimore: Williams and Williams, 1994.

    Google Scholar 

  3. 3.

    Foley RN, Parfrey PS, Harnett JD et al. Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. Kidney Int 1995; 47: 186–192.

    Google Scholar 

  4. 4.

    Silberg JS, Barre PE, Prichard SS, Snidermann SD. Impact of left ventricular hypertrophy on survival in end-stage renal disease. Kidney Int 1989; 36: 286–290.

    Google Scholar 

  5. 5.

    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988; 319: 1701–1707.

    Google Scholar 

  6. 6.

    Dey AB, Kenny RA. Orthostatic hypotension in the elderly: aetiology, manifestations andmanagement. Journal of the Irish Colleges of Physicians and Surgeons 1998; 27: 182–187.

    Google Scholar 

  7. 7.

    Schreiber MJ. Clinical dilemmas in dialysis: managing the hypotensive patient. Setting the stage. Am J Kid Dis 2001; 38 (Suppl 4): S1–S105.

    Google Scholar 

  8. 8.

    Malik S, Winney RJ, Ewing DJ. Chronic renal failure and cardiovascular autonomic function. Nephron 1986; 43: 191–195.

    Google Scholar 

  9. 9.

    Ingall TJ, McLeod JG, O'Brien PC. The effect of ageing on autonomic nervous system function. Austral New Z J Med 1990; 20: 570–577.

    Google Scholar 

  10. 10.

    Jassal SV, Douglas JF, Stout RW. Prevalence of central autonomic neuropathy in elderly dialysis patients. Nephrol Dial Transplant 1998; 13: 1702–1708.

    Google Scholar 

  11. 11.

    Lindberg JS, Moe SM. Osteoporosis in end-stage renal disease. Semin Nephrol 1999; 19: 115–122.

    Google Scholar 

  12. 12.

    Tinetti ME, Mendes de Leon CF, Doucette JT, Baker DI. Fear of falling and fall-related efficacy in relationship to functioning among community-living elders. J Gerontol 1994; 49: M140–M147.

    Google Scholar 

  13. 13.

    Tinetti ME, Baker DI, McAvay G et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821–827.

    Google Scholar 

  14. 14.

    McIntosh S, DaCosta D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Age and Ageing 1993; 22: 53–58.

    Google Scholar 

  15. 15.

    Ward C, Kenny RA. Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med 1996; 100: 418–422.

    Google Scholar 

  16. 16.

    Mathias CJ, Bannister R. Investigation of autonomic disorders. In: Bannister R, Mathias CJ, eds. Autonomic Failure: A Textbook of the Autonomic Nervous System. Oxford: Oxford Medical Publications, 1992: 255–290.

    Google Scholar 

  17. 17.

    Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: 10 years experience in diabetes. Diabetes Care 1985; 8: 491–498.

    Google Scholar 

  18. 18.

    Swift CG. Falls in late life and their consequencesimplementing effective services. BMJ 2001; 322: 855–857.

    Google Scholar 

  19. 19.

    Rosansky SJ, Rhinehart R, Whittman D, Menachery SJ. Comparison of autonomic function using Valsalva ratio and 30:15 postural ratio prior to and after haemodialysis treatment. Clinical Autonomic Research 1995; 5: 151–154.

    Google Scholar 

  20. 20.

    Staessen JA, Bieniaszewski L, O'Brien ET, Fargard R. What is normal blood pressure on ambulatory monitoring? Nephrol Dial Transplant 1996; 11: 241–245.

    Google Scholar 

  21. 21.

    Coomer RW, Schulman G, Breyer JA, Shyr Y. Ambulatory blood pressure monitoring in dialysis patients and estimation of mean interdialytic blood pressure. Am J Kid Dis 1997; 29: 678–684.

    Google Scholar 

  22. 22.

    Foley RN, Parfrey PS, Harnett JD, Kent GM, Murray DC, Barre PE. Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease. Kidney Int 1996; 49: 1379–1385.

    Google Scholar 

  23. 23.

    Locatelli F, Bommer J, London GM et al. Cardiovascular determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant 2001; 16: 459–468.

    Google Scholar 

  24. 24.

    Treatment of Adults and Children with Renal Failure. Third Edition. London, UK: Royal College of Physicians and Renal Association, 2002

  25. 25.

    Keene GS, Parker MJ, Pryor GA. Mortality and morbidity after hip fractures. BMJ 1993; 307: 1248–1250.

    Google Scholar 

  26. 26.

    Cruz DN. Midodrine: a selective alpha-adrenergic agonist for orthostatic hypotension and dialysis hypotension. Expert Opin Pharmacother 2000; 1: 835–840.

    Google Scholar 

  27. 27.

    Agrawal A, Saran R, Khanna R. Management of orthostatic hypotension from autonomic dysfunction in diabetics on peritoneal dialysis. Perit Dial Int 1999; 19: 415–417.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Russell G. Roberts.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Roberts, R.G., Anne Kenny, R. & Brierley, E.J. Are elderly haemodialysis patients at risk of falls and postural hypotension?. Int Urol Nephrol 35, 415–421 (2003).

Download citation

  • Autonomic function
  • Dialysis
  • Elderly
  • Falls
  • Orthostatic hypotension