Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study

Kutner, Nancy G.; Zhang, Rebecca; Huang, Yijian; Painter, Patricia

doi:10.1053/j.ajkd.2015.01.024

Cited by 156 publications

(134 citation statements)

References 30 publications

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“…These observations collectively imply an integrated role of vitamin D for bone and muscle health. Such a role may have substantial clinical implications, especially for CKD patients, in which musculoskeletal alterations and their complications, including muscle pain and weakness, sarcopenia, fatigability, reduced exercise tolerance, fractures, and falls, adversely affect quality of life and survival 12, 13, 14, 15, 16, 17…”

Section: Introductionmentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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The spectrum of activity of vitamin D goes beyond calcium and bone homeostasis, and growing evidence suggests that vitamin D contributes to maintain musculoskeletal health in healthy subjects as well as in patients with chronic kidney disease (CKD), who display the combination of bone metabolism disorder, muscle wasting, and weakness. Here, we review how vitamin D represents a pathway in which bone and muscle may interact. In vitro studies have confirmed that the vitamin D receptor is present on muscle, describing the mechanisms whereby vitamin D directly affects skeletal muscle. These include genomic and non‐genomic (rapid) effects, regulating cellular differentiation and proliferation. Observational studies have shown that circulating 25‐hydroxyvitamin D levels correlate with the clinical symptoms and muscle morphological changes observed in CKD patients. Vitamin D deficiency has been linked to low bone formation rate and bone mineral density, with an increased risk of skeletal fractures. The impact of low vitamin D status on skeletal muscle may also affect muscle metabolic pathways, including its sensitivity to insulin. Although some interventional studies have shown that vitamin D may improve physical performance and protect against the development of histological and radiological signs of hyperparathyroidism, evidence is still insufficient to draw definitive conclusions.

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Section: Introductionmentioning

confidence: 99%

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Molina

Carrero

Bover

et al. 2017

J cachexia sarcopenia muscle

102

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“…These guidelines recommend assessment of physical functioning using both self-reported and openfield measures of physical performance [2,5,6]. In particular, self-reported measures of physical functioning have the advantage of being simple and easy to use [2].…”

Section: Introductionmentioning

confidence: 99%

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

et al. 2018

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Background: Patients undergoing hemodialysis (HD) have difficulty performing activities of daily living (ADL) compared to healthy people. ADL difficulty is an early predictor of loss of independence and mortality in older community-living people. However, determinants of ADL difficulty in HD patients have not been clarified. This study aimed to identify factors associated with ADL difficulty in ambulatory HD patients. Methods: Subjects were 216 Japanese outpatients (130 men, 86 women; mean age, 67 years) undergoing maintenance HD three times a week. Clinical characteristics, depressive symptoms, motor function (leg strength, balance, and walking speed), and ADL difficulty related to lower-limb function such as mobility issues were compared across three difficulty levels (higher, middle, and lower) as classified according to the percentages of patients with perceived difficulty. Multivariate logistic regression analysis was performed to examine whether clinical characteristics, depressive symptoms, and motor function could discriminate ADL difficulty at each level. Receiver operating characteristic curve analysis was performed to determine cut-off values of motor function for predicting ADL difficulty at each level. Results: ADL difficulty was independently associated with age (odds ratio (OR) = 1.05, 95% confidence interval (CI) 1. 00-1.10; P = 0.039), presence of depressive symptoms (OR = 4.24, 95%CI 1.13-15.95; P = 0.033), and usual walking speed (OR = 0.94, 95%CI 0.90-0.97; P < 0.001) for higher level difficulty; age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006), maximum leg strength (OR = 0.97, 95%CI 0.94-1.00; P = 0.043), and usual walking speed (OR = 0.96, 95%CI 0.93-0.98; P = 0.001) for middle level difficulty; and age (OR = 1.06, 95%CI 1.02-1.10; P = 0.006) and usual walking speed (OR = 0.93, 95%CI 0.90-0. 6; P < 0.001) for lower level difficulty. Cut-off values of usual walking speed for predicting ADL difficulty for higher, middle, and lower level difficulty were 83.7, 75.5, and 75.1 m/min, respectively. Conclusions: A slow walking speed and old age were significantly and independently associated with ADL difficulty in ambulatory HD patients. Presence of depressive symptoms was significantly and independently associated with ADL difficulty at the higher level of difficulty in ambulatory HD patients. These findings provide useful data for planning effective therapeutic regimens to prevent ADL difficulty in ambulatory HD patients.

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“…Gait speed is reliable(4–8) and valid across many populations, including older adults, multiple sclerosis, stroke, hemodialysis, and chronic obstructive pulmonary disease (COPD)(6,9–13). Gait speed also predicts important outcomes, including mortality, hospitalization, functional decline, discharge location, falls, and need for services.…”

Section: Introductionmentioning

confidence: 99%

“…Gait speed also predicts important outcomes, including mortality, hospitalization, functional decline, discharge location, falls, and need for services. (10,13–16)…”

Section: Introductionmentioning

confidence: 99%

Evaluating Physical Outcomes in Acute Respiratory Distress Syndrome Survivors

Chan

Friedman

Dinglas

et al. 2016

Critical Care Medicine

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Objective To examine the reliability, validity, responsiveness, and minimal important difference of the 4-meter (4-m) gait speed test in acute respiratory distress syndrome (ARDS) survivors. Design Secondary analyses of data from two longitudinal follow-up studies of ARDS survivors. Test-retest and inter-rater reliability, construct validity (convergent, discriminant, known group), predictive validity, and responsiveness were examined. The minimal important difference was estimated using anchor- and distribution based approaches. Setting A national multicenter prospective study (ARDSNet Long-Term Outcome Study [ALTOS]) and a multi-site prospective study in Baltimore, MD (Improving Care of Acute Lung Injury Patients [ICAP]). Patients ARDS survivors with 4-m gait speed assessment up to 60 months after ARDS (ALTOS, N=184; ICAP, N=122). Interventions Not Applicable Measurements and Main Results 4-m gait speed was assessed at 6 and 12 months follow-up (ALTOS) and 36, 48 and 60 months follow-up (ICAP). Excellent test-retest (ICC: 0.89–0.99 across studies and follow-up) and inter-rater (ICC: 0.97) reliability were found. Convergent validity was supported by moderate-to-strong correlations (69% of 32 >0.40) with other physical function measures. Discriminant validity was supported by weak correlations (86% of 28 <0.30) with mental health measures. Survivors with impaired vs. non-impaired measures of muscle strength and pulmonary function had significantly slower 4-m gait speed (all but one p<0.05). Moreover, 4-m gait speed significantly predicted future hospitalization and health-related quality of life. Gait speed changes were consistent with reported changes in function, supporting responsiveness. The estimated 4-m gait speed MID was 0.03–0.06 m/sec. Conclusions The 4-m gait speed is a reliable, valid, and responsive measure of physical function in ARDS survivors. The estimated minimal important difference will facilitate sample size calculations for clinical studies evaluating the 4-m gait speed test in ARDS survivors.

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Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study

Cited by 156 publications

References 30 publications

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Vitamin D, a modulator of musculoskeletal health in chronic kidney disease

Determinants of difficulty in activities of daily living in ambulatory patients undergoing hemodialysis

Evaluating Physical Outcomes in Acute Respiratory Distress Syndrome Survivors

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