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GERIATRICS

Impact of Drug Use and Comorbidities on In-Hospital Falls in Patients with Chronic Kidney Disease

at time of writing, Research Fellow, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA; now, Manager, Global Health Economics, ConvaTec, A Bristol-Myers Squibb Co., Skillman, NJ

Joseph Gomes, PharmD MS

Medical Liaison, Medical Affairs, UCB Inc., Antioch, IL

Kim C Coley, PharmD

Associate Professor, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

Reprints: Dr. Coley, Department of Pharmacy and Therapeutics, University of Pittsburgh, 921 Salk Hall, 3501 Terrace St., Pittsburgh, PA 15261, coley{at}pitt.edu

BACKGROUND: In-hospital falls are a major problem in healthcare institutions and contribute to morbidity and mortality in this setting. Patients with chronic kidney disease (CKD) were previously found to be at higher risk for experiencing an in-hospital fall.

OBJECTIVE: To evaluate the association between comorbidities and drug use with the risk of in-hospital falls in adults with CKD.

METHODS: A retrospective case-control study was conducted in patients with CKD hospitalized between January 1, 1998, and June 30, 2003. Cases included patients who experienced an in-hospital fall, were 18 years of age or older, and had been hospitalized for more than 24 hours. For every case, 2 controls were identified and matched for CKD, age, and sex. Information about comorbidities and drug use was collected from an electronic medical data repository. Statistical tests performed were t-tests, ² analysis, and multivariate logistic regression, using occurrence of a fall as the dependent variable and race, comorbidities, and drug groups as covariates.

RESULTS: There were 635 fall cases that met study criteria. The mean age of patients was 68 ± 15 years, 54% were female, and 82% were white. There were 1270 matched controls with CKD who were included in the regression analysis. Comorbidities that increased the likelihood of experiencing an in-hospital fall were dementia (OR 2.63), pneumonia (OR 1.72), gastrointestinal disease (OR 1.41), and diabetes (OR 1.31). Drugs associated with an in-hospital fall were antidepressants (OR 1.65) and anticonvulsants (OR 1.52).

CONCLUSIONS: Several comorbidities, especially dementia, significantly increase the risk of experiencing an in-hospital fall in patients with CKD. Drugs that place CKD patients at risk include antidepressants and anticonvulsants.

Key Words: in-hospital falls, kidney disease

Published Online, September 4, 2007. www.theannals.com, DOI 10.1345/aph.1H631