Kinematic and Kinetic Analysis of Gait in Maintenance Hemodialysis Patients

Abstract

To elucidate the gait characteristics of hemodialysis patients, their gaits were analyzed from kinematic and kinetic viewpoints. The gait of 23 patients in the hemodialysis group was measured using a motion capture system and a force plate. We calculated the joint angles and joint moments of the hip, knee, and ankle joints during one gait cycle. The hemodialysis group was compared with 30 patients in a control group utilizing the AIST gait database 2019. The hemodialysis group had a shorter step length and a greater step width than the control group. In the hemodialysis group, the hip flexion angle at the initial contact, the knee flexion angle at the loading response, and the hip flexion angle at the terminal swing were small. The ankle plantarflexion angle at the loading response and the knee flexion angle at the terminal stance were large. The hip extension moment in the loading response and the knee extension moment in the pre-swing were also large. The knee extension moment and the ankle joint dorsiflexion moment in the loading response were small, as was the knee joint flexion moment at the terminal stance. The walking velocity of the hemodialysis patients was maintained by increasing the walking rate against the reduced step length to increase walking stability in the front–back direction. However, the step width was increased to increase stability in the lateral direction, resulting in inefficient walking. The heel rocker was not functioning in the loading response, so the hip extension moment was increased to provide stable weight-bearing and forward body movement. From the terminal stance to the pre-swing, the knee joint extension increased to control the knee joint and compensate for forward acceleration. The gait of maintenance hemodialysis patients was different from that of healthy subjects. Compensatory movements were observed to compensate for the difference, resulting in inefficient gait. If compensatory movements are observed and walking becomes inefficient, it is predicted to decrease independence in walking, cause a decline in ADL, and fall in the future. Therefore, it is necessary to improve the function of the lower limb joints, especially the knee and ankle joints, reduce the burden on other muscles and joints, and modify the gait to use the muscles that should be used.