Signatures of Gait Movement Variability in CKD Patients Scheduled for Hemodialysis Indicate Pathological Performance Before and After Hemodialysis: A Prospective, Observational Study

Zemp, Damiano D.; Giannini, Olivier; Quadri, Pierluigi; Rabuffetti, Marco; Tettamanti, Mauro; Bruin, Eling D. de

doi:10.3389/fmed.2021.702029

Cited by 5 publications

(4 citation statements)

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“…An increased attentional component of gait could unmask other CKD-associated deficits such as neuropathy and balance impairment [ 17 , 18 ], manifesting in shortened steps. This possibility is supported by enhanced cognitive-motor interference in older adults with CKD [ 19 , 20 ]. Effects of cerebrovascular disease and other alterations of brain function associated with CKD could also negatively impact the gait cycle; indeed, the previously described gait phenotype was associated with brain atrophy in regions linked with both motoric and cognitive control of gait [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Step length and fall risk in adults with chronic kidney disease: a pilot study

et al. 2022

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Background Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease. Methods We performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status. Results Assessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status. Conclusions Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.

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Section: Discussionmentioning

confidence: 99%

Step length and fall risk in adults with chronic kidney disease: a pilot study

et al. 2022

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“…An important limitation of pedometers is undercounting steps in individuals with short step length and slow gait speed (14). This is particularly relevant among individuals with advanced kidney disease, in whom such gait abnormalities are common (15)(16)(17)(18). More recently, several studies have used triaxial wrist-worn accelerometers and monitored patients for 4-5 weeks (19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients

et al. 2022

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Background: Physical inactivity is common in patients receiving hemodialysis, but activity patterns throughout the day and in relation to dialysis are largely unknown. This knowledge gap can be addressed by long-term, continuous activity monitoring, but this has not been attempted and may not be acceptable to dialysis patients. Methods: Ambulatory patients with end-stage kidney disease receiving thrice-weekly hemodialysis wore commercially available wrist-worn activity monitors for 6 months. Step counts were collected every 15 minutes and were linked to dialysis treatments. Physical function was assessed using the Short Physical Performance Battery (SPPB). Fast time to recovery from dialysis was defined as ≤2 hours. Mixed effects models were created to estimate step counts over time. Results: Of 52 patients enrolled, 48 were included in the final cohort. The mean age was 60 years, and 75% were Black or Hispanic. Comorbidity burden was high, 38% were transported to and from dialysis by paratransit, and 79% had SPPB <10. Median accelerometer use (199 days) and adherence (95%) were high. 42 patients (of 43 responders) reported wearing the accelerometer every day, and few barriers to adherence were noted. Step counts were lower on dialysis days (3991 (95% CI 3187-4796) vs. 4561 (95% CI 3757-5365)), but step count intensity was significantly higher during the hour immediately following dialysis than during the corresponding time on non-dialysis days (188 steps/hour increase (95% CI 171-205)); these levels were the highest noted at any time. Post-dialysis increases were more pronounced among patients with fast recovery time (225 (95% CI 203-248) vs. 134 (95% CI 107-161) steps/hour) or those with SPPB≥7. Estimates were unchanged after adjustment for demographics, diabetes status, and ultrafiltration rate. Conclusions: Long-term, continuous monitoring of physical activity is feasible in hemodialysis patients. Highly granular data collection and analysis yielded new insights into patterns of activity following dialysis treatments.

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“…Renal replacement therapies such as hemodialysis, peritoneal dialysis and renal transplantation are the mainstay therapies for patient with ESRD [101][102][103][104][105][106][107][108][109][110]. The dysbiosis of gut microbiota was involved in these renal replacement therapies [111][112][113][114].…”

Section: Intervention Strategies Through Regulating Gut Microbiota In...mentioning

confidence: 99%

Recent advances of gut microbiota in chronic kidney disease patients

Zhao

2022

Exploration of Medicine

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Chronic kidney disease (CKD) is a worldwide public health issue and has ultimately progressed to an end-stage renal disease that requires life-long dialysis or renal transplantation. However, the underlying molecular mechanism of these pathological development and progression remains to be fully understood. The human gut microbiota is made up of approximately 100 trillion microbial cells including anaerobic and aerobic species. In recent years, more and more evidence has indicated a clear association between dysbiosis of gut microbiota and CKD including immunoglobulin A (IgA) nephropathy, diabetic kidney disease, membranous nephropathy, chronic renal failure and end-stage renal disease. The current review describes gut microbial dysbiosis and metabolites in patients with CKD thus helping to understand human disease. Treatment with prebiotics, probiotics and natural products can attenuate CKD through improving dysbiosis of gut microbiota, indicating a novel intervention strategy in patients with CKD. This review also discusses therapeutic options, such as prebiotics, probiotics and natural products, for targeting dysbiosis of gut microbiota in patients to provide more specific concept-driven therapy strategy for CKD treatment.

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Signatures of Gait Movement Variability in CKD Patients Scheduled for Hemodialysis Indicate Pathological Performance Before and After Hemodialysis: A Prospective, Observational Study

Cited by 5 publications

References 77 publications

Step length and fall risk in adults with chronic kidney disease: a pilot study

Step length and fall risk in adults with chronic kidney disease: a pilot study

Continuous Long-Term Physical Activity Monitoring in Hemodialysis Patients

Recent advances of gut microbiota in chronic kidney disease patients

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