Abstract
BackgroundGait speed (GS) and handgrip strength (HGS), both factors associated with frailty and sarcopenia, are reportedly associated with CV events in the general population. However, little is known about the impact of these factors on the outcome of patients on dialysis. This study aimed to evaluate whether evaluation of GS and HGS could be associated the onset of fatal/non-fatal cardiovascular (CV) events in patients on haemodialysis (HD).MethodsOne-hundred-eighty-two patients with end-stage renal disease (ESRD) undergoing HD at four dialysis clinics in April 2015 provided written informed consent to participate in the study. We excluded patients who had physical disability, were unable to walk without help, or had recently experienced CV events. Usual GS over a 4-m walk and HGS were measured at baseline, and 173 patients (men, 124; women, 49) were divided into sex-specific quartiles according to GS and HGS and were followed-up for fatal/non-fatal CV events for a median of 2 years. We examined the association of GS and HGS with CV events and determined cut-off values using Cox regression analysis adjusted for age, sex, HD duration, history of CVD, and diabetes.ResultsDuring the follow-up period, 46 CV events occurred. Both physical performance factors were significantly associated with CV events. Low GS (< 0.82 m/s for men and 0.81 m/s for women) and weak HGS (< 29.0 kg for men and 19.7 kg for women) were associated with CV events. For low vs. high GS, the hazard ratio (HR) for CV events was 2.29 [95% confidence interval (CI): 1.20–4.33; P = 0.01], and for low vs. high HGS, the HR was 2.15 [95% CI: 1.00–5.04; P < 0.05]. These HRs remained significant after adjusting for confounding factors, such as sex, age, dialysis vintage, history of CV disease, and diabetes.ConclusionsSlow GS and weak HGS in patients on HD were suggested to be independent predictors of fatal/non-fatal CV events.
Highlights
Gait speed (GS) and handgrip strength (HGS), both factors associated with frailty and sarcopenia, are reportedly associated with CV events in the general population
The deterioration of renal function leads to a variety of metabolic disorders in patients with end stage renal disease (ESRD), including chronic inflammation, uraemia, oxidative stress, insulin resistance, and malnutrition, which increases the risk of frailty and sarcopenia [5, 6]
Previous studies have suggested that several features of frailty or sarcopenia, such as exhaustion, slow GS, low HGS, low physical activity level, and low skeletal muscle mass, constitute the criteria associated with the onset of CV events [12, 13]
Summary
Gait speed (GS) and handgrip strength (HGS), both factors associated with frailty and sarcopenia, are reportedly associated with CV events in the general population. Frailty and sarcopenia were associated with poor outcomes, including falls, incident disability, hospitalization, and mortality [7, 8], and cardiovascular (CV) events [9], such as myocardial infarction (MI), heart failure, and cerebrovascular disorders. The frailty assessment includes the following five items in the frailty phenotype protocol: weight loss, exhaustion, low physical activity level, low handgrip strength (HGS) as weakness, and slow gait speed (GS) as physical disability [10]. Previous studies have suggested that several features of frailty or sarcopenia, such as exhaustion, slow GS, low HGS, low physical activity level, and low skeletal muscle mass, constitute the criteria associated with the onset of CV events [12, 13]
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