title: Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study.
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.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  Survival; hospitalization; activities of daily living (ADL) difficulty; 36-Item Short Form Health Survey (SF-36) Physical Function score.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Nancy G
authors.initials: NG
authors.lastname: Kutner
authors.affiliation: 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.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Yijian
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Physical Therapy, University of Utah, Salt Lake City, UT.
authors.forename: Patricia
authors.initials: P
authors.lastname: Painter
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D005684:Gait / Q000502:physiology*; D006760:Hospitalization; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D009026:Mortality; D011379:Prognosis; D011446:Prospective Studies; D006435:Renal Dialysis; D014481:United States; D055815:Young Adult
keywords: Activities of daily living (ADL) difficulty; US Renal Data System (USRDS); dismobility; end-stage renal disease (ESRD); functional status; gait speed; hemodialysis; hospitalization; mortality; physical functioning; walking ability
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