Abstract: FR-PO861

Low Gait Speed and Difficulty with ADLs in Incident ESKD Patients

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Moorthi, Ranjani N., Indiana University-Indianapolis, Indianapolis, Indiana, United States
  • Avin, Keith, Indiana University-Indianapolis, Indianapolis, Indiana, United States
  • Thadhani, Ravi I., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Moe, Sharon M., Indiana University-Indianapolis, Indianapolis, Indiana, United States
Background

A gait speed less than 0.8 m/s is associated with poor muscle strength and lower life expectancy in community dwelling elderly. In dialysis patients, low gait speed is associated with poor outcomes but this has not been robustly shown in incident patients. We hypothesized that a gait speed < 0.8 m/s is associated with poor muscle strength and difficulty with activities of daily living (ADL) in those new to dialysis.

Methods


"LUCID" is a longitudinal study of subjects incident to dialysis. This analysis was limited to Indiana University cohort who underwent measures of physical function; we examined the cross-sectional relationship between gait speed < 0.8 m/s and hand grip strength, demographics and ADLs collected on the SF36 by multivariate regression analyses. Data is presented as mean (SD) or median (IQR).

Results


Mean (SD) age of the 146 subjects was 54 (13) years; 54% were men, 71% were black, 53% had diabetes, and median dialysis vintage was 90(65) days. Median gait speed was 0.77(0.25) m/s. Hand grip strength was significantly lower in those with gait speed < 0.8 m/s: left hand 16 (10) vs 22 (16) kg, p<0.001; right gave similar results. Presence of diabetes significantly increased odds of lower gait speed by 2.9 fold (p=0.004), and a lower pre-dialysis diastolic BP, but not systolic, was associated with low gait speed (p=0.02). In a multiple logistic regression model, increased age, presence of DM and female gender were significantly associated with risk of gait speed less than 0.8 m/s.
We then determined the association for a low gait speed of < 0.8 m/s to the SF36 questions: No difficulty climbing a flight of stairs decreased the risk by 0.11 times (P = 0.001); Inability to walk several blocks increased the risk by 3.4 times (p=0.008). Median gait speed was significantly lower in those subjects "who never exercised" compared to those were less sedentary: 0.68 (0.32) versus 0.79 (0.30), p=0.046. In a multiple linear regression model, higher age, female sex, poor grip strength and the inability to walk several blocks were associated with lower average gait speed (adjusted R2 0.38).

Conclusion

Lower skeletal muscle strength is associated with impaired mobility in patients new to dialysis. Older females with diabetes remain at greatest risk for mobility impairment. Poor gait speed is associated with decreased ability to perform ADLs in an incident dialysis population.

Funding

  • NIDDK Support