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

Abstract

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.

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Correspondence to Russell G. Roberts.

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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). https://doi.org/10.1023/B:UROL.0000022866.07751.4a

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