Calf circumference predicts falls in older patients on hemodialysis
Calf circumference, higher BMI and age are predictors of falls among older patients on hemodialysis, according to data published in the Journal of Renal Nutrition.
Further, higher BMI as a predictor of falls may reflect sarcopenic obesity.
“Several tools have been developed to assess the risk of falls in the elderly,” Rosilene M. Elias, MD, PhD, from the University of São Paulo in Brazil, and colleagues wrote. “However, a standardized tool for use in hemodialysis services, and particularly for older individuals, has not been clearly defined. Calf circumference measurement is considered a simple and inexpensive way to check muscle mass and has been already used in studies as a simplified way to assess the presence of sarcopenia, which has been associated with falls in the general population. However, so far, calf circumference, as an isolate measurement, has not been applied to evaluate falls in patients on hemodialysis.”
In a prospective study, researchers investigated calf circumference in 91 patients (69.2% were men; 56% had diabetes) aged 65 years or older on maintenance hemodialysis. During 6-month follow-up, researchers assessed whether calf circumference could predict falls among the patients. Patients received care at two dialysis centers in Sao Paulo, Brazil, between June 1, 2019, and June 30, 2020.
Researchers collected clinical and demographic data at baseline and used interviews and charts to determine history of falls throughout the follow-up.
Researchers used an inelastic measuring tape to measure calf circumference on the most protruding part of left leg, except for left-handed older patients, for which the measurement was carried out on the right leg. A reduced calf circumference was defined as less than 34 cm for men and less than 33 cm for women. Additionally, researchers assessed the physical status of patients using Duke activity status index and handgrip strength.
During 6-month follow-up, 13 falls occurred, one of which led to a fracture and death. Patients who fell were older, had a higher BMI, and often had sarcopenic-obesity. A logistic regression model revealed that reduced calf circumference, older age and higher BMI independently correlated with falls in a fully adjusted model.
“The measurement of calf circumference is an easy and not-expensive tool that should be incorporated as a screening assay to prevent falls in older individuals on hemodialysis,” Elias and colleagues wrote. “Patients with reduced calf circumference (particularly those with high body mass index) should be closely monitored for the risk of falls. Actions should include stimulating regular strength exercises, avoiding hypotensive episodes (adjust medications and ultrafiltration rate during dialysis), avoiding environmental hazards at home (do not use slip shoes, ask for help during baths or when moving positions) and at the dialysis clinic (after dialysis do not go out unaccompanied after dialysis and do not get out of the chair quickly).”
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