Observational Study
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World J Nephrol. Aug 6, 2014; 3(3): 101-106
Published online Aug 6, 2014. doi: 10.5527/wjn.v3.i3.101
Gait speed and hospitalization among ambulatory hemodialysis patients: USRDS special study data
Nancy G Kutner, Rebecca Zhang, Yijian Huang, Haimanot Wasse
Nancy G Kutner, Rebecca Zhang, Yijian Huang, USRDS Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA 30322, United States
Haimanot Wasse, Renal Division, Department of Medicine, and USRDS Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA30322, United States
Author contributions: Zhang R had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis; Kutner NG, Zhang R, Huang Y, and Wasse H contributed to study concept and design, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content; Kutner NG acquired the data, obtained funding, provided administrative, technical and material support, and drafted the manuscript; Kutner NG and Wasse H provided study supervision; Zhang R and Huang Y provided statistical analysis.
Supported by National Institutes of Health contract HHSN267200715004C, ADB No. N01-DK-7-5004 (Dr. Kutner)
Correspondence to: Nancy G Kutner, PhD, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Rd NE, Atlanta, GA 30322, United States. nkutner@emory.edu
Telephone: +1-404-7125561 Fax: +1-404-7125895
Received: April 13, 2014
Revised: June 17, 2014
Accepted: July 15, 2014
Published online: August 6, 2014
Abstract

AIM: To assess the association of measured gait speed with hemodialysis (HD) patients’ hospitalization, in conjunction with, and apart from, recent fall history.

METHODS: Gait speed was measured by a standard protocol and falls during the past 12 mo were ascertained for a prevalent multi-center HD cohort (n = 668) aged 20-92. Hospitalization during the past 12 mo was identified in the patient’s clinic records, and the first hospitalization after gait speed assessment (or the competing event of death) was identified in the 2013 United States Renal Data System Standard Analysis Files.

RESULTS: Slow gait speed, defined as < 0.8 m/s, characterized 34.7% of the patients, and 27.1% had experienced a recent fall. Patients with slow gait speed but without a history of recent falls were 1.79 times more likely to have been hospitalized during the past 12 mo (OR = 1.79, 95%CI: 1.11-2.88, P = 0.02), and patients with slow gait speed and a history of recent falls were over two times more likely to have been hospitalized (OR = 2.10, 95%CI: 1.19-3.73, P = 0.01), compared with patients having faster gait speed and no recent fall history. Prospective examination of gait speed/fall history status in relation to first hospitalization (or death) incurred by the end of follow-up December 31, 2011 also showed that slow gait speed was associated with these events in conjunction with a history of falls (HR = 1.54, 95%CI: 1.04-2.30, P = 0.03).

CONCLUSION: The International Task Force on Nutrition and Aging reported that gait speed is a powerful predictor for older adults of adverse outcomes such as hospitalization. In our data, gait speed--apart from, as well as in conjunction with, recent fall history--was associated with HD patients’ hospitalization for multiple causes. Gait speed may be a sensitive health indicator among HD patients across the age spectrum.

Keywords: Falls, Gait speed, Hemodialysis, Hospitalization, Walking disability

Core tip: Walking places demands on the heart, lungs, circulatory, nervous, and musculoskeletal systems. Studies of older adults support the prognostic importance of slowed gait speed for the risk of poor health and function, including hospitalization. However, little is known about the association of gait speed with hemodialysis (HD) patient outcomes. The usual gait speed of 668 HD patients was measured in a United States Renal Data System special study. Slowed gait speed--apart from, as well as in conjunction with, recent fall history--was associated with HD patients’ hospitalization for multiple causes. Gait speed may be a useful monitoring tool in the HD clinical setting.