Study links kidney disease to gait abnormalities, fall prevalence

Patients with decreased kidney function, at any stage, should be evaluated for gait abnormalities and would benefit from fall prevention programs, according to a study published in Nephrology Dialysis Transplantation.

Perspective from Sheila Deziel, RN

Patients with chronic kidney disease tend to experience gait abnormalities. This may lead to a deterioration of daily activity, lower quality of life and a higher risk of fall in these patients. Therefore, researchers investigated the link between CKD, gait abnormalities and fall prevalence to determine a graded association between these variables.

“In this population-based study, we studied the independent associations of kidney function with gait pattern and various gait domains,” the authors wrote. “In addition, we investigated whether the association between kidney function and prevalence of fall is stronger in subjects with lower gait scores.

Collaborators investigated data of 1,430 patients from the Rotterdam Study. Patients had a mean age of 60 years. They assessed patients’ eGFR and albumin to creatinine ratio to determine kidney function. To assess gait abnormalities, researchers analyzed global gait and gate velocity, as well as seven other gait domains including: rhythm, phases, variability, pace, tandem, turning and base of support. To relate these variables to fall prevalence, they evaluated the data against the number of falls patients experienced in the previous year.

Researchers found that lower eGFR and a higher albumin to creatinine ratio were linked with lower global gait scores. The association between impaired kidney function and prevalence of falling was only found in patients with these lower gait scores.

“Given the high occurrence of falls in patients with kidney disease, gait abnormalities could be considered as potential predisposing factors for higher risk fall in these patients,” the authors wrote. “Most gait domains, variability in particular, are difficult, if not impossible to measure visually; hence, a thorough computerized gait assessment is potentially a useful tool to identify people most in need of fall prevention programs.” – by Scott Buzby

Disclosures: The authors reported no relevant financial disclosures.

Perspective

Sheila Deziel, RN

This paper examines the role that CKD plays in gait pattern and fall risk as compared to the general population. The 1,430 patients were obtained from the Rotterdam Study and include a thorough assessment of glomerular filtration rate, albumin-to-creatinine ratio along with global gait, gait velocity and gait patterns. The results demonstrate that worsening kidney function impacts the risk of falls, particularly in those with lower gait scores. This validates that fall prevention programs in the CKD population will be prudent to prevent the long-term complications associated with falls.

This is the first such study associating fall risk with gait function and kidney disease and showed an independent association between kidney function and git function and speed. The gait assessment was done using an electronic platform requiring the participant to walk in a normal fashion and pace, a heel-to-toe fashion, as well as a turning pattern. The authors state that identifying gait variability is nearly impossible to visually see and that the use of the computerized program was key to identifying those at risk. A well-detailed statistical analysis was used to compare the components above and to demonstrate reliability and validity.

Sheila Deziel, RN

Clinical support specialist at Fresenius Renal Technologies

Mesa, Arizona

Disclosures: Deziel is a clinical support specialist at Fresenius Renal Technologies and reports no other relevant financial disclosures.

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Source:

Sedaghat S, et al. Nephrol Dial Transplant. 2018;doi:10.1093/ndt/gfy043.