title: Tests of neuromuscular function are associated with fractures in patients with chronic kidney disease.
abstract: BACKGROUND
  Fractures are common in individuals with chronic kidney disease (CKD), and tests of neuromuscular function (NMT) discriminate well among fractured and non-fractured patients with Stage 5 CKD on dialysis. The ability of NMT to discriminate fracture status in patients with Stages 3-5 CKD is unknown.
  
  
  METHODS
  In this cross-sectional study, we sought to determine in adult patients with Stages 3-5 CKD (eGFR by the Modification of Diet in Renal Disease equation) if NMT [timed up and go (TUG), 6-min walk (6MW) and grip strength] could discriminate fracture status (self-reported low-trauma fractures since age 40 and/or vertebral fractures by morphometry). We conducted logistic regression and receiver-operating characteristic (ROC) curves for each predictor [expressed as area under the ROC curves (AUROC) with 95% confidence intervals (CI)].
  
  
  RESULTS
  Data was available for 125 men and 86 women. The mean age was 63.3 ± 15.5 years, duration of CKD was 96.7 ± 125.3 months and one-third had diabetes. Patients with fractures were older and fell more frequently (P < 0.05). After adjusting for age, weight and sex, for every standard deviation increase in TUG and 6MW, the risk of fracture increased [odds ratio (OR): 1.68; 95% CI: 1.40-2.02] and decreased (OR: 0.53; 95% CI: 0.52-0.54), respectively. Both the TUG and 6MW could discriminate among those with and without fractures (AUROC: 0.90; 95% CI:0.84-0.95, AUROC: 0.87; 95% CI: 0.80-0.94, respectively).
  
  
  CONCLUSIONS
  The TUG and 6MW are able to discriminate fracture status in patients with Stages 3-5 CKD. These tests do not require specialized expertise/equipment and are an inexpensive method to assess for the presence of fractures.
authors.affiliation: Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada. sarah.west@utoronto.ca
authors.forename: Sarah L
authors.initials: SL
authors.lastname: West
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015519:Bone Density; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000209:etiology* / Q000503:physiopathology; D005919:Glomerular Filtration Rate; D018737:Hand Strength; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011379:Prognosis; D012372:ROC Curve; D016103:Spinal Fractures / Q000209:etiology* / Q000503:physiopathology; D055815:Young Adult
chemical_list: D003404:Creatinine