Topics: Faculty, Research

December 14, 2020

People with chronic kidney disease who also suffer from depressive disorders—a long-term chronic form of depression—are more likely to suffer a fall or fall-related injuries, says a Ball State University researcher.

Brandon Kistler, an assistant professor of nutrition and dietetics in Ball States College of Health, was part of a multi-university research team. The study found chronic kidney disease (CKD) patients with depressive disorders (DEP), also called dysthymia, were significantly more likely to report falls (87% higher odds) and fall-related injuries (58% higher odds) compared to those with no history of DEP despite adjustment for sociodemographic characteristics, lifestyle and health behaviors, and chronic disease comorbidity burden.

The professor collaborated on the report, "Depressive Disorders Are Associated With Risk of Falls in People With Chronic Kidney Disease." The study was published in the November issue of The Journal of the American Psychiatric Nurses Association (JAPNA), a peer-reviewed bi-monthly publication.

"There are many reasons that we may have observed a higher incidence of falls and fall-related injuries among patients with CKD and DEP," Kistler said. "DEP are associated with changes in sleep, nutritional status, and gait, which may contribute to a greater risk of falls."

In addition to potential physiological and psychological differences, Kistler pointed out the medications used to treat DEP are also associated with fall and fracture risk, with the highest risk often occurring in the first few weeks after initiation.

Using the Behavioral Risk Factor Surveillance System, researchers identified 16,574 adults with CKD. Patients with CKD were stratified by history of self-reported DEP.

Kistler noted that CKD is a major health issue in the United States that affects nearly 14% of adults and is associated with increased hospitalization rates and premature mortality.

Due to the high rates of DEP and falls among patients with CKD, this new study's findings may have important implications for nurses and psychiatrists, but prospective studies are needed to confirm the results.

While fall risk assessments and processes to minimize the risk of falls are often mandated, nurses may benefit from increased awareness that medications used to treat DEP may affect fall and injury risk among patients with CKD, especially in the short-term.

"Nurses caring for people receiving dialysis are critical to the early recognition of mental health concerns, given the greater amount of time in contact with dialysis patients," Kistler said. "Nurses are in the ideal position to engage professionals such as mental health nurse practitioners, psychologists, social workers, complementary therapists, and exercise professionals to facilitate nonpharmacological interventions. Similarly, nurses working in the kidney transplant area, supportive care, and early CKD cohorts can pursue these strategies in each different kidney care context."