Nutrition-Focused Physical Examination and Functional Phenotypes Are Associated with Fall Risk in Hemodialysis Patients: A Prospective Pilot Study.

BACKGROUND

Hemodialysis (HD) patients face a markedly higher risk of falls compared to the general population, leading to fractures, functional decline, and increased mortality. Malnutrition, particularly protein-energy wasting (PEW), is thought to contribute to this vulnerability; however, few studies have prospectively examined the predictive value of nutrition-focused and functional phenotypes in fall risk assessment.

METHODS

In this prospective, single-center study, 68 adult HD patients were followed over two years for fall events. Nutritional status was assessed biannually using the Nutrition-Focused Physical Exam (NFPE), serum albumin, and other biochemical markers. Clinical, biochemical, and functional parameters were compared between patients who experienced one or more falls and those who did not, and multivariable logistic regression identified independent predictors of falls.

RESULTS

Falls occurred in 38.2% of participants, with 45% of these resulting in major injuries. NFPE-related malnutrition (OR= 6.684, p = 0.020), lower albumin levels (OR=0.160, p=0.015), assisted or dependent ambulation (OR=19.167, p=0.001), and orthostatic hypotension (OR=4.979, p=0.035) were identified as significant fall risk factors. Lower potassium levels were significantly associated with falls in bivariate analysis (p = 0.001) and showed a borderline association in multivariable analysis (p=0.053).

CONCLUSIONS

NFPE-defined malnutrition and functional impairment were independently associated with higher odds of falls in this pilot cohort. Routine incorporation of NFPE, targeted nutritional optimization, and functional support strategies may help inform future fall-risk assessment strategies. Larger multicenter studies are needed to validate these findings and to further clarify the potential role of potassium balance in fall risk among hemodialysis patients.