Abstract
Increased fear of falling (FOF) increases the risk of falling and is an important issue for living an independent life. Patients undergoing hemodialysis (HD) frequently fall, and this may be attributed to increased FOF due to common fall risk factors as well as severe chronic kidney disease and HD-related factors. The purpose of this narrative review was to summarize the current knowledge on the mechanisms of increased FOF leading to falls in patients undergoing HD. Patients undergoing HD have enhanced FOF compared to community elderly people. Furthermore, an increase in FOF is correlated with a decrease in physical activity and physical function. It has been reported that FOF in patients undergoing HD may be associated with past and future falls, and the risk of falling increases sharply when FOF exceeds a certain threshold. Increased FOF may serve as a fundamental mechanism leading to increased fall risk by interacting with physical inactivity and physical frailty, affecting lower limb muscle activity during walking. Further research is needed to clarify the relationship between increased FOF and falls in patients undergoing HD. Regular clinical assessment of FOF is critical for identifying fall risk in patients undergoing HD.