ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: TH-PO307

Dialysis Therapy and Gait Speed: A Repeated Measures Analysis of US Patients on Chronic Dialysis

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Carlos, Christopher A., University of California, San Francisco, San Francisco, California, United States
  • Grimes, Barbara A., UCSF, San Francisco, California, United States
  • Johansen, Kirsten L., University of California, San Franicsco, San Francisco, California, United States
Background

Slow gait speed, a patient-centered yet understudied clinical outcome, is a common and independent predictor of future disability, hospitalizations and death among patients with chronic kidney disease. Prior studies have shown that improper fluid management is a likely contributor to physical impairment, but lack of data on the relative importance of the many fluid-related components of dialysis therapy (e.g. baseline fluid overload, blood pressure, and ultrafiltration rate) has limited consensus and evidence-based guideline development. Analyses are needed to understand which managed aspects of dialysis therapy are most associated with functional status declines.

Methods

We measured gait speed at baseline, 12 months, and 24 months, among 652 patients on hemodialysis recruited in the ACTIVE/ADIPOSE cohort study. We used linear mixed effects modeling to examine associations between demographic, comorbid, social, and laboratory data with gait speed trajectory. We then added degree of bioimpedance-measured predialysis volume overload (defined as a fluid state >= 15% relative to extracellular water volume in men and >=13% in women), dialysis treatment time, ultrafiltration rate, and predialysis systolic blood pressure to ascertain whether treatment-related factors were associated with gait speed or its change over time.

Results

Mean gait speed at baseline was 0.94 m/s and declined an average of 0.08 m/s per year. In adjusted analysis, nonwhite race (-0.14 m/s, 95% CI -0.19 to -0.08), female sex (-0.10 m/s, 95% CI -0.13 to -0.06), and BMI > 35 kg/m2 (-0.09 m/s, 95% CI -0.15 to -0.03) were associated with slower gait speeds. Predialysis volume overload was associated with slower gait speed (-0.06 m/s, 95% CI -0.11 to -0.01), but was not a statistically meaningful predictor of future gait speed trajectory. Dialysis treatment time, ultrafiltration rate, and predialysis systolic blood pressure were not independently associated with gait speed.

Conclusion

Certain factors place patients on dialysis at increased risk of slowed gait speed, including a state of predialysis volume overload. Interventions that focus on limiting states of volume overload, compared to other managed aspects of the dialysis treatment, may be more meaningful in limiting gait speed impairment.

Funding

  • NIDDK Support