title: Dialytic hemodynamics are associated with changes in gait speed.
abstract: Functional impairment and reduced mobility are prevalent in patients on chronic hemodialysis (HD). The impact of HD on physical performance and mobility needs evaluation.
  
  
  
  We measured gait speed in a cohort of chronic HD patients both pre and post an HD session. We collected demographic and laboratory data and dialytic hemodynamic parameters for the HD session. Participants completed the Falls Efficacy Scale International (FES-I) survey to assess concern for falling. We used linear regression analysis to tests for associations between our predictor variables of intra-dialytic hemodynamic change and change in gait speed from pre to post HD (primary outcome) and FES-I score (secondary outcome).
  
  
  
  Twenty-eight participants completed the study. The mean (SD) age was 64.0 (10.5) years. The majority were male (71.4%), had hypertension (85.7%) and diabetes (57.1%). The mean (SD) change in gait speed from pre to post dialysis was -0.06 (0.08) m/s. A greater decrease in gait speed was associated with greater decrease in SBP and DBP from pre to post HD (p = 0.02 and p = 0.04, respectively) and greater maximum drop in SBP and DBP during HD (p = 0.01 and p <0.01, respectively). The association between maximum drop in SBP and DBP and gait speed remained significant after adjustment for covariates. There was no association between BP change and FES-I score.
  
  
  
  Our results suggest that HD patients who have greater decrease in BP during HD are at risk for decreased gait speed post HD.
authors.affiliation: Division of Medicine, Section of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.|Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Dawn F
authors.initials: DF
authors.lastname: Wolfgram
authors.affiliation: Department of Medicine, Division of Nephrology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Zubin
authors.initials: Z
authors.lastname: Lathara
authors.affiliation: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.affiliation: Division of Primary Care, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA.|Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Whittle
mesh_terms: D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D000072797:Walking Speed / Q000187:drug effects*
keywords: Hemodialysis; blood pressure; mobility; physical performance