Abstract
BackgroundPatients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease.MethodsWe performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status.ResultsAssessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status.ConclusionsStep length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.
Highlights
Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries
Patients with end-stage renal disease (ESRD) had poorer physical function than patients with non-dialysis dependent chronic kidney disease (CKD) (SPPB score 7.4 ± 2.6 vs. 8.2 ± 2.6, p = 0.1; gait speed 0.8 ± 0.2 vs. 1.0 ± 0.3 m/s, p < 0.001; handgrip strength 22.2 ± 12.5 vs. 28.2 ± 10.2 kg, p = 0.03), they were not older. For both gait speed and step length, we noted strong within-visit correlations between measurements taken during the two 4-m walks conducted at each visit (Fig. 2A, B)
We considered whether low step length and slow gait speed provided additive information (Table 3)
Summary
Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. We explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease. Detection of patients at high risk of these complications remains suboptimal; it is imperative to develop methods that are feasible to implement in clinical nephrology practice. Our work and that of others have identified other abnormalities of gait among adults with CKD [10, 11]; these are present even among individuals with preserved gait speed and are associated with elevated risk of falls and development of cognitive impairment, the latter of which can further exacerbate fall risk [10, 12, 13]
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