Kidney Week

Abstract: SA-PO716

Quantitative Gait Abnormalities and Risk of Falls in CKD

Session Information

• Geriatric Nephrology
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

• 1100 Geriatric Nephrology

Authors

• Tran, Jeannie, UCLA, Culver City, California, United States

Jeannie Tran,

• Ayers, Emmeline, Albert Einstein College of Medicine, New York, New York, United States

Emmeline Ayers,

• Verghese, Joe, AECOM, Bronx, New York, United States

Joe Verghese,

• Abramowitz, Matthew K., Albert Einstein College of Medicine, New York, New York, United States

Matthew K. Abramowitz,

Background

Physical function is impaired in people with chronic kidney disease (CKD), leading to a high risk of falls and the development of disability. It is not known whether gait abnormalities are present which may explain their risk of falling.

Methods

Quantitative and clinical gait assessments and kidney function measurement were performed in 330 community dwelling adults aged 65 years and older. Fall history was obtained every two months by standardized telephone questionnaire. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m². Cox proportional hazards models adjusted for demographics, comorbidities, and history of falls were created to examine the risk of falls.

Results

Participants with CKD had slower gait speed, as well as gait cycle abnormalities including shorter stride length and greater time in the stance and double-support phases. Cadence and stride length variability did not differ between CKD and non-CKD. Among people with CKD, lower eGFR was significantly associated with the severity of gait cycle abnormalities (per 10 mL/min/1.73m² lower eGFR: 3.6 cm (95% CI 1.4-5.8) shorter stride length; 0.7% (95% CI 0.3-1.0) greater time in stance phase; 1.1% (95% CI 0.5-1.7) greater time in double-support phase) after adjustment for demographics and comorbidities, and these abnormalities mediated the association of lower eGFR with slower gait speed. The associations with eGFR remained significant after adjustment for measures of cognitive function, muscle strength, and sensory neuropathy. On clinical gait exam, consistent with the quantitative abnormalities, short steps and marked sway or loss of balance with straight or tandem walking were more common among participants with CKD, yet the majority had no identifiable gait phenotype. A gait phenotype defined by these abnormal gait signs was associated with the risk of incident falls among participants with CKD (compared with non-CKD without gait phenotype: HR 1.8 (95% CI 1.2-2.9, p=0.01) for CKD with phenotype, HR 0.9 (95% CI 0.6-1.5, p=0.72) for CKD without phenotype).

Conclusion

The association of CKD with slow gait speed is explained by more proximal changes in gait. A newly identified gait phenotype predicts fall risk among older adults with CKD.

Funding

• NIDDK Support