Quantitative gait markers and the TUG time in chronic kidney disease

Abstract

BackgroundPoor gait performance results in more fall incidents among people with chronic kidney disease (CKD). It is unknown what specific quantitative gait markers contribute to high fall risk in CKD and the size of their mediation effects. MethodsWe included 634 participants from the Taizhou Imaging Study who had complete gait and laboratory data. Quantitative gait assessment was conducted with a wearable insole-like device. Factor analysis was utilized to summarize fifteen highly correlated individual parameters into five independent gait domains. Prevalent CKD was defined as an estimated glomerular filtration rate (eGFR)<60 ml/min per 1.73 m2, which was calculated based on cystatin C. Regression models were created to examine the associations of prevalent CKD with quantitative gait markers and the TUG time. Mediation analysis was used to investigate whether poor quantitative gait parameters could be mediators and the proportion of their mediation effects. ResultsParticipants with prevalent CKD had a higher TUG time (odds ratio=2.02, P=0.025) and poor gait performance in the phase domain (standardized β=-0.391, FDR=0.009), including less time in the swing phase (standardized β=-0.365, FDR=0.027) and greater time in the double-support phase (standardized β=0.367, FDR=0.027). These abnormalities mediated the association of prevalent CKD with a high TUG time (for the swing phase: 31.6%, Pmediation=0.044; for the double-support phase: 29.6%, Pmediation=0.042; for the phase domain: 26.9%, Pmediation=0.048). ConclusionPoor phase-related gait abnormalities mediated the relationship between CKD and a high TUG time, suggesting that incorporating quantitative gait markers in specific domains may improve fall prevention programs for individuals with CKD.