Abstract
Walking ability is significantly lower in hemodialysis patients compared to healthy people. Decreased walking ability characterized by slow walking speed is associated with adverse clinical events, but determinants of decreased walking speed in hemodialysis patients are unknown. The purpose of this study was to identify factors associated with slow walking speed in ambulatory hemodialysis patients. Subjects were 122 outpatients (64 men, 58 women; mean age, 68 years) undergoing hemodialysis. Clinical characteristics including comorbidities, motor function (strength, flexibility, and balance), and maximum walking speed (MWS) were measured and compared across sex-specific tertiles of MWS. Univariate and multivariate logistic regression analyses were performed to examine whether clinical characteristics and motor function could discriminate between the lowest, middle, and highest tertiles of MWS. Significant and common factors that discriminated the lowest and highest tertiles of MWS from other categories were presence of cardiac disease (lowest: odds ratio [OR] = 3.33, 95% confidence interval [CI] = 1.26–8.83, P<0.05; highest: OR = 2.84, 95% CI = 1.18–6.84, P<0.05), leg strength (OR = 0.62, 95% CI = 0.40–0.95, P<0.05; OR = 0.57, 95% CI = 0.39–0.82, P<0.01), and standing balance (OR = 0.76, 95% CI = 0.63–0.92, P<0.01; OR = 0.81, 95% CI = 0.68–0.97, P<0.05). History of fracture (OR = 3.35, 95% CI = 1.08–10.38; P<0.05) was a significant factor only in the lowest tertile. Cardiac disease, history of fracture, decreased leg strength, and poor standing balance were independently associated with slow walking speed in ambulatory hemodialysis patients. These findings provide useful data for planning effective therapeutic regimens to prevent decreases in walking ability in ambulatory hemodialysis patients.
Highlights
Recent studies have shown that walking ability is a powerful predictor of life expectancy among older adults [1,2,3,4]
Significant differences across tertiles of walking speed were found in age (P
We categorized MWS into sex-specific tertiles to identify determinants of decreased walking speed, as clinical differences might exist in risk factors associated with slow walking speed by category
Summary
Recent studies have shown that walking ability is a powerful predictor of life expectancy among older adults [1,2,3,4]. Assessment and management of risk factors related to slow walking speed may be necessary to implement effective disease management and secondary interventions for patients with chronic diseases. Maintenance hemodialysis patients often have several complications and comorbidities, including diabetes, orthopedic abnormality, peripheral neuropathy, and peripheral artery disease, which directly or indirectly cause deterioration in walking ability [13,14,15,16,17]. These underlying conditions complicate the identification of determinants of slow walking speed
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