Abstract
BackgroundPeople with Chronic Kidney Disease (CKD) often present with prevalent gait impairment and high fall rates, particularly in advanced CKD stages. Gait impairment and its consequences is associated with increased hospital admission, institutionalization, and greater need for health care. The objective of this systematic review was to evaluate the quality of studies investigating CKD patients’ gait characteristics at different CKD stages, to highlight areas of agreement and contradiction between studies reporting aspects of gait in CKD, and to discuss and emphasize gait parameters associated with fall risk.MethodsWe performed a literature search of trials in CINAHL (EBSCO), Cochrane Library, EMBASE, Medline (EBSCO), PEDro, PubMed, and Scopus databases from their inception to June 30th 2018 using a two-stage process for the identification of studies. We retrieved English-, German-, Italian-, Spanish-, Portuguese and Dutch-language articles for review. Methodological quality of randomized and non-randomized studies was assessed with an adapted version of the Downs and Black checklist.ResultsThirty-one studies (22 cross-sectional with 3901 participants) and 9 longitudinal intervention studies (1 randomized control trial, 5 controlled clinical trials and 3 one-group pre-post-test; with 659 participants) were considered. The studies revealed a primary emphasis on gait speed measures within clinical tests, and a neglect of spatiotemporal gait variables. Most of the studies showed that CKD progression is associated with slowing of walking speed. No studies analysed the relation between gait parameters and fall risk.ConclusionsThere was a paucity of studies investigating aspects of gait quality in patients with CKD. In the majority of studies, only gait speed is analysed as a performance indicator. The relation between gait parameters and fall risk in CKD is not investigated. We formulate several recommendations to fill the current research gap, encourage the use of standardized gait analysis protocols that include assessment of spatiotemporal parameters in clinical care of patients with CKD, aimed at prevention of mobility decline and falls risk.
Highlights
People with Chronic Kidney Disease (CKD) often present with prevalent gait impairment and high fall rates, in advanced CKD stages
Falls related gait parameters No studies analysed the relation between gait parameters and fall risk
Our review uncovers a rather narrow view on gait assessment in patients with CKD, with the main focus on determining and reporting gait speed, which decreases with increasing CKD severity
Summary
People with Chronic Kidney Disease (CKD) often present with prevalent gait impairment and high fall rates, in advanced CKD stages. Gait impairment and its consequences is associated with increased hospital admission, institutionalization, and greater need for health care. The objective of this systematic review was to evaluate the quality of studies investigating CKD patients’ gait characteristics at different CKD stages, to highlight areas of agreement and contradiction between studies reporting aspects of gait in CKD, and to discuss and emphasize gait parameters associated with fall risk. Chronic Kidney Disease (CKD) is defined as abnormalities in kidney structure or function, present for 3 months, with implications for health [1]. A potential outcome of CKD is end-stage renal disease (ESRD), Falls in elderly patients on dialysis are common. Recent studies show higher fall rates and fracture risk already in CKD patients not on dialysis [9, 10]. Results from a retrospective cohort analysis seems to indicate, that dialysis therapy initiation may
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