1
|
Zhang X, Wang H, Lu H, Fan M, Tian W, Wang Y, Cui M, Jiang Y, Suo C, Zhang T, Jin L, Xu K, Chen X. Quantitative gait markers and the TUG time in chronic kidney disease. Heliyon 2024; 10:e35292. [PMID: 39170243 PMCID: PMC11336600 DOI: 10.1016/j.heliyon.2024.e35292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 08/23/2024] Open
Abstract
Background Poor 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. Methods We 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. Results Participants 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 %, P mediation = 0.044; for the double-support phase: 29.6 %, P mediation = 0.042; for the phase domain: 26.9 %, P mediation = 0.048). Conclusion Poor 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.
Collapse
Affiliation(s)
- Xin Zhang
- School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Hao Wang
- School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Heyang Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Min Fan
- Taixing Disease Control and Prevention Center, Taizhou, Jiangsu, China
| | - Weizhong Tian
- Taizhou People's Hospital Affiliated to Nantong University, Taizhou, Jiangsu, China
| | - Yingzhe Wang
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
| | - Mei Cui
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yanfeng Jiang
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
| | - Chen Suo
- School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Tiejun Zhang
- School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Li Jin
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
| | - Kelin Xu
- School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
| | - Xingdong Chen
- Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China
- State Key Laboratory of Genetic Engineering, Zhangjiang Fudan International Innovation Center, School of Life Sciences, Human Phenome Institute, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Yiwu Research Institute of Fudan University, Yiwu, Zhejiang, China
| |
Collapse
|
2
|
Fulinara CP, Huynh A, Goldwater D, Abdalla B, Schaenman J. Frailty and Age-Associated Assessments Associated with Chronic Kidney Disease and Transplantation Outcomes. J Transplant 2023; 2023:1510259. [PMID: 37038595 PMCID: PMC10082678 DOI: 10.1155/2023/1510259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/03/2023] [Accepted: 02/06/2023] [Indexed: 04/04/2023] Open
Abstract
Background. Frailty is often defined as a decrease in physiological reserve and has been shown to be correlated with adverse health outcomes and mortality in the general population. This condition is highly prevalent in the chronic kidney disease (CKD) patient population as well as in kidney transplant (KT) recipients. Other age-associated changes include sarcopenia, nutrition, cognition, and depression. In assessing the contributions of these components to patient outcomes and their prevalence in the CKD and KT patient population, it can be determined how such variables may be associated with frailty and the extent to which they may impact the adverse outcomes an individual may experience. Objectives. We sought to perform a systematic literature review to review published data on frailty and associated age-associated syndromes in CKD and KT patients. Results. Over 80 references pertinent to frailty, sarcopenia, nutrition, cognition, or depression in patients with CKD or KT were identified. Systematic review was performed to evaluate the data supporting the use of the following approaches: Fried Frailty, Short Physical Performance Battery, Frailty Index, Sarcopenia Index, CT scan quantification of muscle mass, health-related quality of life, and assessment tools for nutrition, cognition, and depression. Conclusion. This report represents a comprehensive review of previously published research articles on this topic. The intersectionality between all these components in contributing to the patient’s clinical status suggests a need for a multifaceted approach to developing comprehensive care and treatment for the CKD and KT population to improve outcomes before and after transplantation.
Collapse
Affiliation(s)
- Christian P. Fulinara
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Alina Huynh
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Deena Goldwater
- Divisions of Geriatrics and Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Basmah Abdalla
- Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Joanna Schaenman
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| |
Collapse
|
3
|
Jayakody O, Blumen HM, Ayers E, Verghese J. Risk factors for decline in gait speed during walking while talking in older adults. Gait Posture 2022; 96:67-72. [PMID: 35594829 PMCID: PMC9894014 DOI: 10.1016/j.gaitpost.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Slow gait speed during Walking While Talking (walking while reciting alternate letters of the alphabet; WWT) is associated with an increased risk of developing dementia and falls. The aim of this study was to examine longitudinal changes in WWT-speed and to identify risk factors that may modify the rate of change in WWT-speed. METHODS A total of 431 older participants (55.7% female; M Age=76.8 ± 6.4 years; mean follow up 2.1 ± 1.8 years) enrolled in the Central Control of Mobility in Aging study were examined. WWT-speed (cm/s) was measured with a computerized walkway. The following baseline measures were examined as risk factors: demographics [age, sex, education], medical illnesses [hypertension, diabetes, cardiac arrhythmias, history of stroke, Parkinson's disease, kidney disease, arthritis], cognitive functions [global cognition, executive function, processing speed], physical and sensory functions [unipedal stance time, gait speed during single task walking, visual acuity], psychological variables [depression, anxiety] and falls. Linear mixed effect models were used to examine 1) change in WWT-speed over time, and 2) risk factors associated with change in WWT-speed over time. RESULTS WWT-speed declined in an accelerating non-linear fashion over time after adjusting for baseline age, sex and education. The rate of decline in WWT-speed was modified by older age (b -0.16 95%CI -0.22, -0.09), poorer balance (b -1.73 95%CI -2.57, -0.90), and faster gait speed during single task walking (b -0.06 95%CI -0.08, -0.04). SIGNIFICANCE This study identified fixed and modifiable risk factors of faster decline in WWT-speed over time in community-residing older adults.
Collapse
Affiliation(s)
- Oshadi Jayakody
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Helena M. Blumen
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Emmeline Ayers
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA,Correspondence to: Albert Einstein College of Medicine, 1225 Morris Park Avenue, Bronx 10461, USA, (J. Verghese)
| |
Collapse
|
4
|
Ho JQ, Verghese J, Abramowitz MK. Serum bicarbonate levels and gait abnormalities in older adults: a cross-sectional study. Sci Rep 2022; 12:9171. [PMID: 35654910 PMCID: PMC9163170 DOI: 10.1038/s41598-022-12907-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Metabolic acidosis is associated with impaired physical function in patients with chronic kidney disease (CKD) and older adults. However, whether acidosis is associated with gait abnormalities has received little attention. In a cohort of 323 community-dwelling adults ≥ 65 years old who underwent quantitative gait analysis, we examined associations of serum bicarbonate with eight individual gait variables. After multivariable adjustment, participants in the lowest bicarbonate tertile (< 25 mEq/L) had 8.6 cm/s slower speed (95% confidence interval [CI] 3.2–13.9), 7.9 cm shorter stride length (95% CI 3.5–12.2), and 0.03 s longer double support time (95% CI 0.002–0.1) compared with those in the middle tertile (25–27 mEq/L). Furthermore, lower bicarbonate levels were associated with more severe gait abnormalities in a graded manner. After further adjustment for possible mediating factors, associations were attenuated but remained significant. Among participants with CKD, associations were of similar or greater magnitude compared with those without CKD. Factor analysis was performed to synthesize the individual gait variables into unifying domains: among the pace, rhythm, and variability domains, lower serum bicarbonate was associated with worse performance in pace. In sum, lower serum bicarbonate was independently associated with worse performance on several quantitative measures of gait among older adults.
Collapse
Affiliation(s)
- Jim Q Ho
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, 10461, USA
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, 10461, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Matthew K Abramowitz
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, 10461, USA. .,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA. .,Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
5
|
Kimura A, Paredes W, Pai R, Farooq H, Buttar RS, Custodio M, Munugoti S, Kotwani S, Randhawa LS, Dalezman S, Elters AC, Nam K, Ibarra JS, Venkataraman S, Abramowitz MK. Step length and fall risk in adults with chronic kidney disease: a pilot study. BMC Nephrol 2022; 23:74. [PMID: 35193493 PMCID: PMC8862327 DOI: 10.1186/s12882-022-02706-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background 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. 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. Methods We 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. Results Assessments 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. Conclusions Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.
Collapse
Affiliation(s)
- Atsumi Kimura
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - William Paredes
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Rima Pai
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Hina Farooq
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Rupinder S Buttar
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Matthew Custodio
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Samhitha Munugoti
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Sonia Kotwani
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Lovepreet S Randhawa
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Solomon Dalezman
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Antonio C Elters
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Kate Nam
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Jose S Ibarra
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Sandheep Venkataraman
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA
| | - Matthew K Abramowitz
- Department of Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY, USA. .,Institute for Aging Research, Albert Einstein College of Medicine, Bronx, NY, USA. .,Diabetes Research Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| |
Collapse
|
6
|
Tang CH, Chou CY. Hip fracture in patients with non-dialysis chronic kidney disease stage 5. Sci Rep 2021; 11:20591. [PMID: 34663840 PMCID: PMC8523559 DOI: 10.1038/s41598-021-00157-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 10/05/2021] [Indexed: 01/01/2023] Open
Abstract
Hip fracture is a significant health problem and is associated with increased mortality. Patients with chronic kidney disease (CKD) are more at risk of hip fracture than the general population, but the hip fracture risk is not evident among non-dialysis CKD stage 5 patients. This study aims to assess the risk of hip fracture in patients with non-dialysis CKD stage 5 comparing to those with CKD stages 1-4. Patients with non-dialysis CKD stage 5 and CKD stages 1-4 were retrieved from Taiwan longitudinal health insurance database 2011-2014. All patients were followed to the end of 2018 for the development of hip fractures. We analyze the risk of hip fracture of propensity score-matched patients with CKD stage 5 compared to patients with CKD stages 1-4 using stepwise Cox regression and competing risks regression. We analyzed 5649 propensity score-matched non-dialysis CKD 1-4 patients and non-dialysis CKD 5 patients between 2011 and 2014. All patients were followed to the end of 2018, 229 (4.1%) of CKD 1-4 patients in 21,899 patient-year, and 290 (5.1%) of CKD 5 patients had hip fractures in 18,137 patient-year. CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1-4. The adjusted HR was 1.53 (95% CI 1.08-1.54) in the Cox regression with adjustments for age, gender, comorbidity, and history of fracture. In the competing risks regression, the subdistribution hazard ratio was 1.29 (95% CI 1.08-1.54). Female gender, age, history of fractures, and Charlson-Deyo comorbidity index were independently associated with increased hip fracture risks. Non-dialysis CKD 5 patients had a higher risk of hip fracture than patients with CKD stages 1-4. This association is independent of patients' age, female gender, history of fractures, and comorbidities.
Collapse
Affiliation(s)
- Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan, ROC
| | - Che-Yi Chou
- Division of Nephrology, Asia University Hospital, No. 222, Fuxin Rd, Wufeng Dist., Taichung, 413, Taiwan, ROC.
- Department of Post-Baccalaureate Veterinary Medicine, Asia University, Wufeng, Taichung, Taiwan, ROC.
- Divsion of Nephrology, China Medical University Hospital, Taichung, Taiwan, ROC.
| |
Collapse
|