Dialytic hemodynamics are associated with changes in gait speed

Abstract

Introduction Functional impairment and reduced mobility are prevalent in patients on chronic hemodialysis (HD). The impact of HD on physical performance and mobility needs evaluation. Methods We measured gait speed in a cohort of chronic HD patients both pre and post an HD session. We collected demographic and laboratory data and dialytic hemodynamic parameters for the HD session. Participants completed the Falls Efficacy Scale International (FES-I) survey to assess concern for falling. We used linear regression analysis to tests for associations between our predictor variables of intra-dialytic hemodynamic change and change in gait speed from pre to post HD (primary outcome) and FES-I score (secondary outcome). Findings Twenty-eight participants completed the study. The mean (SD) age was 64.0 (10.5) years. The majority were male (71.4%), had hypertension (85.7%) and diabetes (57.1%). The mean (SD) change in gait speed from pre to post dialysis was −0.06 (0.08) m/s. A greater decrease in gait speed was associated with greater decrease in SBP and DBP from pre to post HD (p = 0.02 and p = 0.04, respectively) and greater maximum drop in SBP and DBP during HD (p = 0.01 and p <0.01, respectively). The association between maximum drop in SBP and DBP and gait speed remained significant after adjustment for covariates. There was no association between BP change and FES-I score. Discussion Our results suggest that HD patients who have greater decrease in BP during HD are at risk for decreased gait speed post HD.

Mobility in Older Adults Receiving Maintenance Hemodialysis: A Qualitative Study

“…Several older adults receiving HD in our study cited HD treatments as acutely worsening their mobility. Although we did not quantitate mobility before and after HD treatments, Wolfgram et al 21 found that gait speeds decreased by 0.06 m/s shortly after a HD session, which is a clinically meaningful change in older adults. 27 In this study, they found that changes in gait speed after HD were associated with the magnitude of systolic and diastolic blood pressure changes during HD.…”

“…In 37 older adults receiving HD, Hall et al 18 found that the mean SPPB score was 6 points, and Chen et al 19 demonstrated that the median SPPB score was 5 points in 50 older adults receiving HD. For gait speed, Zhou et al 20 found that among 36 older adults receiving HD with diabetes, the mean gait speed was 0.4 m/s, and Wolfgram et al 21 found that the mean gait speed before initiating a dialysis treatment was 0.76 m/s in 28 older adults receiving HD. In comparison, the younger participants of the Frequent Hemodialysis Network Trial, 22 who had a mean age of 50.7 years, had a mean SPPB score of 8.5 points at enrollment.…”

Association of Phase Angle, but Not Inflammation and Overhydration, With Physical Function in Peritoneal Dialysis Patients

“…The fluid overload significantly impacts on the physical performance of the patients over time, as observed in a longitudinal study by Carlos et al (12). On the other hand, excessive fluid withdrawal in hemodialysis sessions can lead to intradialytic hypotension, which is associated with a reduced gait after a dialysis session (22,23).…”

Mobility Impairment in Patients New to Dialysis

“…We consistently timed our gait speed and grip strength measures pre- or post-dialysis within individual subjects. This is important since there are changes in gait speed with a single dialysis session, dependent on dialysis run hemodynamics [44]. A limitation of the study is that gait speed was measured post dialysis for the 1st shift subjects (36%) but prior to dialysis session in the rest.…”