Kidney Week

Abstract: SA-OR077

Effects of Age and Hemodialysis on Frailty Prevalence, Gait, and Balance in Diabetic Patients: A Randomized Controlled Trial

Session Information

• Improving Dialysis Delivery and Patient Outcomes
  October 27, 2018 | Location: 2, San Diego Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Geriatric Nephrology

• 1100 Geriatric Nephrology

Authors

• Hamad, Abdullah, Hamad Medical Corporation, Doha, Qatar

Abdullah Hamad, MD



Dr Abdullah Hamad is currently serving as a senior consultant at Hamad General Hospital, Department of Nephrology. He completed his residency in internal medicine and Nephrology at Nassau University Medical Center in New York and Transplant training at Mayo Clinic Medical Center in Rochester MN. He has 15 years track of clinical research, over 50 publications in peer review journals or conference proceedings. He has been principal investigator or co-investigator for many studies. He collaborates with multiple specialty across Hamad Medical Corporation and internationally on multiple clinical research efforts related to dialysis and related illnesses. He received multiple awards including certificate of Star of Excellence from Hamad Medical Corporation.

• Zhou, He, Baylor College of Medicine, Houston, Texas, United States

He Zhou,

• Al-Ali, Fadwa S., Hamad Medical Corporation, Doha, Qatar

Fadwa S. Al-Ali,

• Ibrahim, Rania Abdelaziz, Hamad Medical Corporation, Doha, Qatar

Rania Abdelaziz Ibrahim,

• Talal, Talal, hamad medical corp, Doha, Qatar

Talal Talal,

• Najafi, Bijan, Baylor College of Medicine, Houston, Texas, United States

Bijan Najafi,

Background

Motor skills deteriorates with aging. Some conditions may magnify this deterioration. This study examined whether diabetes and hemodialysis (HD) would negatively impact gait, balance, and physical frailty beyond aging.

Methods

Seventy-three elderly adults with diabetes (age=71.4±5.4 years, BMI=30.8±5.9, 49% were on HD) and seventy-eight mid-age adults with diabetes (age=56.7±5.7 years, BMI=31.1±7.2, 50% were on HD) were recruited. Gait and balance performances were objectively measured using validated wearable sensors at HD clinic. Frailty status was determined by Fried Frailty Criteria.

Results

Aging deteriorated motor-functions (gait and balance) in people with diabetes irrespective of dialysis (9%-46% deterioration, Cohen’s deffect size=0.22-0.42),with largest effect size observed for double support in gait performance (p=0.011).In addition, deteriorations in gait and balance caused by aging were more pronounced among diabetics with HD (19%-65% deterioration, d=0.41-0.75, p<0.05), when compared to diabetics without HD (1%-14% deterioration, d=0.01-0.20, p>0.05). The largest effect size for gait deterioration among diabetics with HD was observed in double support test (d=0.75,p = 0.002, Fig. 1), and the largest effect size for balance deterioration was observed in ankle stability test (d=0.48, p = 0.042, Fig. 1). Diabetics with HD, irrespective of age, had 3 times higher prevalence of frailty than diabetics without HD (42% vs. 14%, p=0.017).

Conclusion

Our study showed that HD deteriorates gait and balance and magnifies prevalence of frailty by factor of 3 beyond aging in people with diabetes. Immobility caused by prolonged HD (4-hour, 3 times per week) and post-dialysis exhaustion may contribute to poorer motor function in older diabetics leading to frailty. This study demonstrated practicality of wearable sensors to assess motor performance in dialysis clinics with opportunity to capture early deterioration.

Fig. 1:Gait and balance comparison between mid-age and elderly diabetic patients with and without HD.

Funding

• Government Support - Non-U.S.