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Vitamin- D deficiency (serum vitamin-D< 15ng/ml) is common among patients on maintenance Hemodialysis , Clinical trials showed that vitamin-D deficiency associated with increased risk of fall in older patients with intact renal function. Such association in hemodialysis population is yet to be proven.
(3650) patients on maintenance hemodialysis in Diaverum Saudia Arabia dialysis centers were included. Serum Vitamin-D level measured and demographic and clinical parameters analyzed , fall risk assessment assessed using Morse Fall Risk Assessment tool and patient grouped as (low risk 0-24), (low to moderate 25-50) and (high risk ≥51) , multivariate regression analysis model with main significant confounders created to analyze independent association between Vitamin-D deficiency and high risk of fall .all tests p-value is significant at < 0.05.
Our cohort characteristics were Male 2098(57%), Diabetic 1785(48%), Vitamin-D deficiency (< 15ng/ml) in 1914(52.4%), age 52.9±14.1 years, body mass index 27.6±6.5 kg/m2, Charlson Comorbidity Index 4.47±1.93 , Karnfosky patient dependency score 83.2%±12.9% , Morse Fall scale (low risk 0-24) 2240 (61.4%), (low to moderate 25-50) 1044(28.6%) and (high risk ≥51) 366(10%).
Serum Vitamin-D level was significantly lower in patients with (high risk ≥51) than patients with (low risk 0-24) 16.24±8.77ng/ml & 18.1±12.5ng/ml respectively p-value 0.04. Also significantly Higher Proportion of patients with vitamin-D deficiency among patients with high risk of fall 215 (58.7%) , compared to moderate risk 556 (53%) and no risk of fall group (1143(51%) chi-square 7.9 p-value 0.019.
Multivariate regression analysis with model including significant confounders in fall risk created and results showed higher risk of fall (high risk ≥51) among patients with Vitamin-D deficiency (< 15ng/ml) OR 1.283[95% CI, 1.019-1.616] (p –value 0. 034), other confounders associated with high risk of fall in the model included, Age ≥65 years old OR 1.909[95% CI, 1.458-2.50] (p-value < 0.001) , Female gender OR 1.635[95% CI, 1.301-2.055] (p-value < 0.001) ,Diabetic patients OR 1.740[95% CI, 1.295-2.337] (p-value < 0.001) , patients with higher Charlson Comorbidity Index (CCI≥6) OR 1.5 [95% CI, 1.092-2.062] (p-value 0.012) , patients with lower Karnfosky Performance Status Scale (KPS <80%) OR 3.237 [95% CI, 2.398-4.370] (p-value < 0.001) and below average Body Mass Index (BMI<18.5 kg/m2) OR 2.08 [95% CI, 1.44-3.027] (p-value < 0.001) .
Vitamin D deficiency (< 15ng/ml) is associated with higher risk of fall defined as Morse fall scale (high risk ≥51) among our hemodialysis cohort independent form other significant confounders ; female gender, older age ≥65, history of diabetes, higher comorbidity index (CCI≥6) , below average body mass index (BMI<18.5 kg/m2) and lower patient Performance Status Scale .