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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association between physical performance and all-cause mortality in CKD.
Baback Roshanravan1, Cassianne Robinson-Cohen, Kushang V Patel
1Division of Nephrology, Department of Medicine, University of Washington Kidney Research Institute, Box 359606, 325 9th Avenue, Seattle, WA 98104, USA. broshanr@u.washington.edu
Journal of the American Society of Nephrology : JASN
|April 20, 2013
Summary
Physical performance decline in chronic kidney disease (CKD) is common. Impaired lower extremity function, particularly gait speed and Timed Up and Go (TUAG), strongly predicts mortality in CKD patients.
Area of Science:
- Nephrology
- Geriatrics
- Physical Medicine
Background:
- Physical performance decline is common in aging and chronic kidney disease (CKD).
- The association between physical performance and clinical outcomes in CKD patients remains unclear.
- CKD often presents with muscle wasting and reduced physical function, mimicking accelerated aging.
Purpose of the Study:
- To investigate the association between physical performance measures and all-cause mortality in individuals with stage 2-4 CKD.
- To compare the predictive power of physical performance tests with traditional markers of kidney function and serum biomarkers for mortality.
Main Methods:
- 385 ambulatory, stroke-free participants with stage 2-4 CKD were evaluated.
- Key physical performance measures included handgrip strength, usual gait speed, Timed Up and Go (TUAG), and 6-minute walking distance.
- Cox proportional hazards models and receiver operating characteristic (ROC) curves were used to assess associations with all-cause mortality over a median 3-year follow-up.
Main Results:
- Lower extremity performance measures (gait speed, TUAG) were significantly impaired compared to normative values.
- Each 0.1 m/s decrement in gait speed was associated with a 26% increased mortality risk.
- Each 1-second increase in TUAG was associated with an 8% increased mortality risk.
- Gait speed and TUAG demonstrated stronger predictive ability for 3-year mortality than estimated glomerular filtration rate (eGFR) or serum biomarkers.
- Incorporating gait speed into predictive models significantly improved mortality prediction.
Conclusions:
- Impaired physical performance, especially of the lower extremities, is prevalent in CKD.
- Physical performance tests, particularly gait speed and TUAG, are strong and independent predictors of all-cause mortality in CKD patients.
- These functional measures offer valuable prognostic information beyond traditional kidney function markers.
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