title: Decline in measured glomerular filtration rate is associated with a decrease in endurance, strength, balance and fine motor skills.
abstract: OBJECTIVE
  Physical performance in chronic kidney disease affects morbidity and mortality. The aim was to find out which measures of physical performance are important in chronic kidney disease (CKD) and if there are associations with declining measured glomerular filtration rate (GFR).
  
  
  METHODS
  Endurance was assessed by 6 min walk test (6-MWT) and stair climbing, muscular endurance by 30 s sit to stand, heel rises and toe lifts, strength by quadriceps- and handgrip-strength, balance by functional reach and Berg's balance scale, and fine motor skills by Moberg's picking-up test. GFR was measured by Iohexol clearance.
  
  
  RESULTS
  The study comprised 101 patients with CKD 3b-5 not started dialysis, 40 women and 61 men, with a mean age of 67 ± 13 (range: 22 - 87) years. All measures of physical performance were impaired. A decrease in GFR of 10 mL/min per 1.73 m2corresponded to a 35 metre shorter walking distance in the 6-MWT. Multivariable linear regression analysis showed significant relationships between decline in GFR and the 6-MWT (P = 0.04), isometric quadriceps strength left (P = 0.04), balance measured as functional reach (P = 0.02) and fine motor skills in the left hand as measured by Moberg's picking-up test (P = 0.01), respectively, after sex, age, comorbidity and the interaction between sex and age had been taken into account.
  
  
  CONCLUSIONS
  Endurance, muscular endurance, strength, balance and fine motor skills were impaired in patients with CKD 3b-5. Walking capacity, isometric quadriceps strength, balance, and fine motor skills were associated with declining GFR. The left extremities were more susceptible to GFR, ageing and comorbidities and seem thus to be more sensitive.
authors.affiliation: Department of Nephrology, Faculty of Medicine, Lund University, Institution of Clinical Sciences, Lund, Sweden.
authors.forename: Matthias
authors.identifier: http://orcid.org/0000-0001-6248-1020
authors.initials: M
authors.lastname: Hellberg
authors.affiliation: Department of Clinical Chemistry and Pharmacology, Institution of Laboratory Medicine, Lund, Sweden.
authors.forename: Peter
authors.identifier: http://orcid.org/0000-0002-8395-922X
authors.initials: P
authors.lastname: Höglund
authors.affiliation: Department of Nephrology, Faculty of Medicine, Lund University, Institution of Clinical Sciences, Lund, Sweden.
authors.forename: Philippa
authors.initials: P
authors.lastname: Svensson
authors.affiliation: Department of Nephrology, Faculty of Medicine, Lund University, Institution of Clinical Sciences, Lund, Sweden.
authors.forename: Huda
authors.initials: H
authors.lastname: Abdulahi
authors.affiliation: Department of Nephrology, Faculty of Medicine, Lund University, Institution of Clinical Sciences, Lund, Sweden.
authors.forename: Naomi
authors.identifier: http://orcid.org/0000-0001-5284-4406
authors.initials: N
authors.lastname: Clyne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage / Q000493:pharmacokinetics; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005081:Exercise Therapy / Q000379:methods; D017079:Exercise Tolerance; D005260:Female; D005919:Glomerular Filtration Rate; D018737:Hand Strength; D006304:Health Status; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage / Q000493:pharmacokinetics; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D018763:Muscle Fatigue; D053580:Muscle Strength; D004856:Postural Balance; D011237:Predictive Value of Tests; D052097:Quadriceps Muscle / Q000503:physiopathology*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy; D000070857:Walk Test; D055815:Young Adult
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: balance; endurance; fine motor skills; glomerular filtration rate; physical performance; strength