Mobility Impairment in Patients New to Dialysis

Abstract

Background: Impaired mobility is associated with functional dependence, frailty, and mortality in prevalent patients undergoing dialysis. We investigated risk factors for mobility impairment, (poor gait speed) in patients incident to dialysis, and changes in gait speed over time in a 2-year longitudinal study. Methods: One hundred eighty-three patients enrolled within 6 months of dialysis initiation were followed up 6, 12, and 24 months later. Grip strength, health-related quality of life, and comorbidities were assessed at baseline. Outcomes were (a) baseline gait speed and (b) change in gait speed over time. Gait speed was assessed by 4-meter walk. Multivariate linear regression was used to identify risk factors for low gait speed at baseline. For longitudinal analyses, linear mixed effects modeling with gait speed modeled over time was used as the outcome. Results: Participants were 54.7 ± 12.8 years old, 52.5% men, 73.9% black with mean dialysis vintage of 100.1 ± 46.9 days and median gait speed 0.78 (0.64-0.094) m/s. Lower health utility and grip strength, diabetic nephropathy, and walking aids were associated with lower baseline gait speed. Loss of 0.1 m/s gait speed occurred in 24% of subjects at 1 year. In multivariate mixed effects models, only age, walking aid use, lower health utility, and lower handgrip strength were significantly associated with gait speed loss. Conclusions: In our cohort of incident dialysis patients, overall gait speed is very low and 54.2% of the subjects continue to lose gait speed over 2 years. Older age, lower handgrip strength, and quality of life are risk factors for slowness. Patients at highest risk of poor gait speed can be identified at dialysis initiation to allow targeted implementation of therapeutic options.

Outcomes of Elderly Patients With Acute Myocardial Infarction and Heart Failure Who Undergo Percutaneous Coronary Intervention

“…23 In addition, chronic kidney disease, a common comorbidity in patients with cardiovascular disease, has been reported to be associated with frailty progression. 24 , 25 Although there were few dialysis patients in the present study, a clinical study has shown progression of mobility impairment in this population. 25 We previously demonstrated that, among nonagenarians with AMI who underwent PCI, the proportion of patients with frailty increased during hospitalization, from 43.8% at admission to 60.7% at discharge.…”

“… 24 , 25 Although there were few dialysis patients in the present study, a clinical study has shown progression of mobility impairment in this population. 25 We previously demonstrated that, among nonagenarians with AMI who underwent PCI, the proportion of patients with frailty increased during hospitalization, from 43.8% at admission to 60.7% at discharge. 15 We also reported that although not significant in a multivariate analysis, frailty progression was more frequently observed in patients with AMIHF than in those with Killip Class 1 disease.…”

Plasma metabolites and physical function in patients undergoing hemodialysis

“…Patients undergoing dialysis have poor skeletal muscle strength and slowed gait speed that increases the risk of functional dependence, frailty, fractures and falls 1 – 5 . In 183 patients new to dialysis, we have demonstrated low grip strength (median 27.0 ± 11.5 kg) and slow gait speed (median 0.78 m/s (0.64–0.94)) 2 . In this cohort, multivariate analyses demonstrated low gait speed was associated with several clinical risk factors including overall health utility indices, diabetic nephropathy, and use of a walking aid.…”

“…Subjects who were enrolled in the Indiana-University Longitudinal Study of Incident Dialysis (IU-LUCID) were recruited from outpatient dialysis units affiliated with Indiana University Health Nephrology and located in inner-city areas 2 . Briefly, eligible participants were > 18 years old, started dialysis within the past 6 months, and had both plasma metabolites and physical function measurements collected at study initiation.…”

Narrative Review: Clinical Implications and Assessment of Frailty in Patients With Advanced CKD

“… 22 , 80 , 81 , 96 Handgrip strength might also offer prognostic utility, demonstrating correlation with gait speed and kidney transplant assessment outcomes, as well as sensitivity to change over acute admission. 125 , 156 , 157 However, impairment of lower limb function, rather than upper limb function, is most predictive of outcomes in CKD studies. 22 , 158 …”