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Abstract: TH-PO264

Wrist-Based Accelerometry and Physical Function in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Kotwani, Sonia, Albert Einstein College of Medicine, Bronx, New York, United States
  • Randhawa, Lovepreet S., Albert Einstein College of Medicine, Bronx, New York, United States
  • Munugoti, Samhitha, Albert Einstein College of Medicine, Bronx, New York, United States
  • Dalezman, Solomon, Island Nephrology Services, Flushing, New York, United States
  • Nam, Kate, Albert Einstein Medical School, Scarsdale, New York, United States
  • Elters, Antonio Carlos, Albert Einstein College of Medicine, Bronx, New York, United States
  • Venkataraman, Sandheep, Montefiore Medical Center, Bronx, New York, United States
  • Paredes, William, Albert Einstein College of Medicine, Bronx, New York, United States
  • Ohri, Nitin, Albert Einstein College of Medicine, Bronx, New York, United States
  • Abramowitz, Matthew K., Albert Einstein College of Medicine, Bronx, New York, United States
  • Ibarra, Jose Sebastian, Albert Einstein College of Medicine, Bronx, New York, United States
Background

Poor physical function is a powerful predictor of adverse outcomes in dialysis patients. Whether daily activity monitoring can detect patients with lower levels of physical function is unknown.

Methods

We conducted a prospective study of wrist-based accelerometry in a single outpatient dialysis unit. Fifty patients receiving thrice-weekly hemodialysis were enrolled and wore a commercial fitness tracker for 6 months. Physical function was assessed by usual gait speed, grip strength, and the Short Physical Performance Battery (SPPB, range 0-12, higher is better). Information on the composite outcome of emergency department (ED) visits or hospitalizations was obtained from monthly patient questionnaires, dialysis unit records, and our hospital electronic medical record. Mixed effects models were created to examine the association of daily step counts with each functional outcome. Poisson regression using generalized estimating equations was used to examine associations with the composite outcome. Models were adjusted for age, sex, race, BMI, and diabetes status.

Results

Data were excluded for 3 patients who did not perform physical function testing. Daily step counts at baseline averaged 4538 +/- 3001. The mean age of the cohort was 60+/-13, 49% were women, 40% were black, 47% had diabetes, and the mean BMI was 28+/-7 kg/m2. For each 1000 steps more per day, gait speed was 1.2 cm/sec faster (95%CI 0.1-2.3); dominant hand grip strength was 0.6 kg higher (95%CI: 0.1-1.1) and SPPB was 0.13 (95% CI: 0.02- 0.23) points higher. Neither SPPB, gait speed, nor grip strength was associated with the composite outcome. However, step counts were associated with the composite outcome even among patients with high SPPB scores: among patients with SPPB>8, every 1000 steps more per day was associated with 50% decreased risk (IRR 0.5, 95% CI 0.39- 0.63); among those with SPPB≤8, there was a 14% decreased risk (IRR 0.86, 95%CI 0.73- 1.00).

Conclusion

Lower step counts are associated with poorer performance on several measures of physical function in dialysis patients and are associated with the risk of hospitalization and ED visits even among patients with preserved physical function.

Funding

  • NIDDK Support