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Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study.
Am J Kidney Dis. 2015 Aug; 66(2):297-304.AJ

Abstract

BACKGROUND

Slow walk (gait) speed predicts functional decline, institutionalization, and mortality risks in the geriatric population. A gait speed evidence base for dialysis patient outcomes is needed.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

752 prevalent hemodialysis (HD) patients aged 20 to 92 years evaluated in 2009 to 2012 in 7 Atlanta and 7 San Francisco clinics in a US Renal Data System special study.

PREDICTOR

Usual walk speed in meters per second, categorized as ≥0.6 m/s (baseline n=575), <0.6 m/s (baseline n=94), and unable to perform walk test (baseline n=83).

OUTCOMES

Survival; hospitalization; activities of daily living (ADL) difficulty; 36-Item Short Form Health Survey (SF-36) Physical Function score.

MEASUREMENTS

Cox proportional hazards models investigated gait speed and mortality over a median follow-up of 703 days. Multivariable logistic or linear regression models estimated associations of baseline gait speed with hospitalization, need for ADL assistance, and SF-36 Physical Function score after 12 months.

RESULTS

Participants who walked ≥0.6 m/s had 53 (9%) deaths, those who walked <0.6 m/s had 19 (20%) deaths, and those unable to walk had 37 (44%) deaths. Adjusted mortality hazard ratios were 2.17 (95% CI, 1.19-3.98) for participants who walked <0.6 m/s and 6.93 (95% CI, 4.01-11.96) for those unable to walk, compared with participants walking ≥0.6 m/s. After 12 months, compared with baseline walk speed ≥ 1.0 m/s (n=169 participants), baseline walk speed of 0.6 to <0.8 m/s (n=116) was associated with increased odds of hospitalization (OR, 2.04; 95% CI, 1.19-3.49) and ADL difficulty (OR, 3.88; 95% CI, 1.46-10.33) and a -8.20 (95% CI, -13.57 to -2.82) estimated change in SF-36 Physical Function score.

LIMITATIONS

Cohort not highly representative of overall US in-center HD population.

CONCLUSIONS

Because walking challenges the heart, lungs, and circulatory, nervous, and musculoskeletal systems, gait speed provides an informative marker of health status. The association of gait speed with HD patients' risk for functional decline warrants continued study.

Authors+Show Affiliations

USRDS Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA; Department of Rehabilitation Medicine, Emory University, Atlanta, GA. Electronic address: nkutner@emory.edu.USRDS Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.USRDS Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA; Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA.Department of Physical Therapy, University of Utah, Salt Lake City, UT.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25824124

Citation

Kutner, Nancy G., et al. "Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: a US Renal Data System Special Study." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 66, no. 2, 2015, pp. 297-304.
Kutner NG, Zhang R, Huang Y, et al. Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study. Am J Kidney Dis. 2015;66(2):297-304.
Kutner, N. G., Zhang, R., Huang, Y., & Painter, P. (2015). Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 66(2), 297-304. https://doi.org/10.1053/j.ajkd.2015.01.024
Kutner NG, et al. Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: a US Renal Data System Special Study. Am J Kidney Dis. 2015;66(2):297-304. PubMed PMID: 25824124.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study. AU - Kutner,Nancy G, AU - Zhang,Rebecca, AU - Huang,Yijian, AU - Painter,Patricia, Y1 - 2015/03/29/ PY - 2014/07/01/received PY - 2015/01/28/accepted PY - 2015/4/1/entrez PY - 2015/4/1/pubmed PY - 2015/10/16/medline KW - Activities of daily living (ADL) difficulty KW - US Renal Data System (USRDS) KW - dismobility KW - end-stage renal disease (ESRD) KW - functional status KW - gait speed KW - hemodialysis KW - hospitalization KW - mortality KW - physical functioning KW - walking ability SP - 297 EP - 304 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 66 IS - 2 N2 - BACKGROUND: Slow walk (gait) speed predicts functional decline, institutionalization, and mortality risks in the geriatric population. A gait speed evidence base for dialysis patient outcomes is needed. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: 752 prevalent hemodialysis (HD) patients aged 20 to 92 years evaluated in 2009 to 2012 in 7 Atlanta and 7 San Francisco clinics in a US Renal Data System special study. PREDICTOR: Usual walk speed in meters per second, categorized as ≥0.6 m/s (baseline n=575), <0.6 m/s (baseline n=94), and unable to perform walk test (baseline n=83). OUTCOMES: Survival; hospitalization; activities of daily living (ADL) difficulty; 36-Item Short Form Health Survey (SF-36) Physical Function score. MEASUREMENTS: Cox proportional hazards models investigated gait speed and mortality over a median follow-up of 703 days. Multivariable logistic or linear regression models estimated associations of baseline gait speed with hospitalization, need for ADL assistance, and SF-36 Physical Function score after 12 months. RESULTS: Participants who walked ≥0.6 m/s had 53 (9%) deaths, those who walked <0.6 m/s had 19 (20%) deaths, and those unable to walk had 37 (44%) deaths. Adjusted mortality hazard ratios were 2.17 (95% CI, 1.19-3.98) for participants who walked <0.6 m/s and 6.93 (95% CI, 4.01-11.96) for those unable to walk, compared with participants walking ≥0.6 m/s. After 12 months, compared with baseline walk speed ≥ 1.0 m/s (n=169 participants), baseline walk speed of 0.6 to <0.8 m/s (n=116) was associated with increased odds of hospitalization (OR, 2.04; 95% CI, 1.19-3.49) and ADL difficulty (OR, 3.88; 95% CI, 1.46-10.33) and a -8.20 (95% CI, -13.57 to -2.82) estimated change in SF-36 Physical Function score. LIMITATIONS: Cohort not highly representative of overall US in-center HD population. CONCLUSIONS: Because walking challenges the heart, lungs, and circulatory, nervous, and musculoskeletal systems, gait speed provides an informative marker of health status. The association of gait speed with HD patients' risk for functional decline warrants continued study. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/25824124/Gait_Speed_and_Mortality_Hospitalization_and_Functional_Status_Change_Among_Hemodialysis_Patients:_A_US_Renal_Data_System_Special_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(15)00493-X DB - PRIME DP - Unbound Medicine ER -