Abstract: FR-PO885

Fall Injury Prediction Using Quadriceps Thickness by Ultrasound Measurement of Patients with ESRD on Hemodialysis: A Prospective Study

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular


  • Tanaka, Yoshihide, Higashiyamato Nangai Clinic, Tokyo, Japan
  • Tanaka, Kentaro, Higashiyamato Nangai Clinic, Tokyo, Japan
  • Kushiyama, Akifumi, Division of Diabetes and Metabolism,The Institute for Adult Diseases, Asahi Life Foundation, Tokyo, Japan
  • Kuki, Atsumi, Higashiyamato Nangai Clinic, Tokyo, Japan
  • Sakai, Ken, Toho University School of Medicine, Ohta-ku, ToKyo, Japan
  • Hara, Shigeko, Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
  • Izumi, Yui, Higashiyamato Nangai Clinic, Tokyo, Japan
  • Ozawa, Takashi, Higashiyamato Nangai Clinic, Tokyo, Japan

Patients with end stage renal disease (ESRD) have an increased risk of fall injury. Recently, quadriceps muscle thickness (QT) by ultrasound (US) measurement has been reported as valid assessment of muscle wasting and physical function and easily applicable at the bedside. The aim of this study is to investigate if QT by US can prospectively predict fall injury in patients with ESRD on hemodialysis.


Within 732 patients with ESRD on hemodialysis at our 4 dialysis Clinics in April 2015, 182 patients provided written informed consent. The QT by US is indicated as the sum of both legs. The relative reliability of QT by US measurement was confirmed using intraclass correlation coefficient(ICC);right QT ICC(1,2)=0.99 and left QT ICC(1,2)=0.98. Patients with unstable condition such as discharge or initiation of oral steroid administration, or drop out before the first measurement were excluded. 179 patients (men127, women52) were studied. A fall was defined as an event in which a person was inadvertently located on the ground or other low position. Fall injury was defined as any injury with a fall, based on patient’s self-report including bone fracture, crack, bleeding, bruise, and abrasion.


Over median 12-month follow-up period, 42 patients (23.4%) developed the fall injury in 179 patients. When subjects were stratified by QT level into sex-specific tertiles, the patients in the lowest tertile (men<3.66cm, women<3.52cm) indicated a significantly higher risk of fall injury than the middle and highest tertiles by using Kaplan Meier estimate (logrank test, p<0.05). In a univariate analysis using Cox regression model, 1cm decrease of the QT by US indicated significant risk increase (hazard ratio 1.85, [95% CI 1.33-2.70], p=0.0002). In multivariate analysis, the hazard ration between the QT by US remained significant after adjusting various confounding factors such as sex, age, dialysis vintage, BMI, diabetes mellitus, nutritional state, grip strength (1.64, 1.04-2.63,0.03).


QT by US is an independent and useful predictor of fall injury in patients with ESRD on hemodialysis.