Falls are among the leading causes of injury and death among adults aged 65 or older. People with chronic kidney disease (CKD) are at increased risk of falling and of having a serious injury from falls. However, information is limited about risk factors for falls and fall-related injuries among people with CKD. We performed a secondary analysis of 157,753 adults (6.1% with CKD) aged 65 or older surveyed in the 2014 Behavioral Risk Factor Surveillance System. People with CKD were at increased risk of falls (odds ratio [OR] = 1.81; 95% confidence interval [CI], 1.63-2.01) and fall-related injuries (OR = 1.50; 95% CI, 1.27-1.78) even after adjusting for differences in demographic characteristics, health conditions, and lifestyle factors (P < .05 for all). Among people with CKD, women, people diagnosed with diabetes, diabetes duration, and arthritis were all significant predictors of falls and fall-related injuries (P < .05 for all). Lifestyle factors, such as engaging in recent exercise (adjusted odds ratio [AOR] = 0.68; 95% CI, 0.56-0.81) and limited physical function (assessed as difficulty in climbing stairs) (AOR = 2.84; 95% CI, 2.30-3.44), were most closely associated with falls and fall-related injuries. Adults aged 65 or older with CKD were at increased risk of falling and of suffering an injury as a result of a fall compared with adults in the same age range without CKD. Potentially modifiable factors such as physical function and recent exercise were most closely related to reduced risk for falls and fall-related injuries and may be an appropriate target for fall prevention and rehabilitation programs in people with CKD.

While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis on conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis.