Falls in Moroccan chronic hemodialysis patients: toward a prevention-focused strategy
Abstract
Falls among patients undergoing maintenance hemodialysis are responsible of considerable morbidity, disability and mortality. Data from North Africa remain scarce. This study aimed to determine the prevalence of falls among Moroccan chronic hemodialysis patients, to identify associated clinical and functional risk factors and to provide insights for implementing prevention strategies. We conducted a multicenter cross-sectional study in four nephrology centers in Casablanca, Morocco. Adult patients receiving hemodialysis for at least six months were included. Falls occurring in the previous 12 months were recorded using a structured questionnaire. Sociodemographic data, comorbidities, and potential fall-related risk factors were collected. Functional mobility was assessed using the Timed Up and Go (TUG) test. Univariate and multivariate logistic regression analyses were performed to identify factors independently associated with falls. A total of 127 patients were included (43.3% were men and 56.7% women). The mean age of the participants was 64.6 ±13.8 years. The prevalence of falls in the last year was 28.3%. In multivariable analyses, vitamin D deficiency (adjusted OR = 2.18; 95% CI 1.11-4.11), orthostatic hypotension (adjusted OR = 1.20; 95% CI 1.21-2.50), balance disorders (adjusted OR = 2.12; 95% CI 1.67-4.60), diabetic neuropathy (adjusted OR = 1.82; 95% CI 1.23-2.20) and sedentary lifestyle (adjusted OR = 2.04; 95% CI 1.20-3.50), were independently associated with falls. Falls are frequent among Moroccan chronic hemodialysis patients, affecting over one-quarter of this population. Modifiable factors such as vitamin D deficiency, balance impairments, diabetic neuropathy, sedentary lifestyle, and orthostatic hypotension increase fall risk. These results underscore the importance of a multidisciplinary, prevention-focused strategy combining medical optimization, rehabilitation, environmental adjustments, and patient education to reduce falls and enhance functional outcomes.