Predictors of physical performance decline in patients receiving maintenance hemodialysis: a prospective...

To identify predictors of physical performance decline in patients receiving maintenance hemodialysis.

This prospective observational study included patients receiving maintenance hemodialysis. Participants underwent assessment of physical performance using the Short Physical Performance Battery (SPPB), the 60-second sit-to-stand (60s-STS) test, handgrip strength, bone mineral density (BMD) by dual-energy X-ray absorptiometry (DEXA), and clinical and laboratory variables. Participants were classified according to changes in SPPB score between baseline and follow-up. The minimal detectable change (MDC) of the SPPB was used as the criterion for defining physical performance decline. Statistical analysis included Student's t-test, the Mann-Whitney test, and chi-square tests. Univariable logistic regression and multivariable penalized logistic regression with Firth correction were used to identify predictors of physical performance decline.

Of the 103 participants, 18 (17.5%) experienced physical performance decline after a mean follow-up of 18.6 ± 10.1 months. Compared with those who maintained physical performance, participants with physical performance decline were older and had lower total and femoral bone mineral density and poorer performance on the 60s-STS test at baseline. In the multivariable penalized logistic regression analysis, lower femoral BMD (OR: 0.997; 95% CI: 0.991-0.999) and longer hemodialysis vintage (OR: 1.009; 95% CI: 1.001-1.039) were independently associated with physical performance decline.

This prospective study showed that lower femoral bone mineral density and longer hemodialysis vintage were independently associated with physical performance decline in patients receiving maintenance hemodialysis. These findings underscore the potential value of longitudinal physical performance assessment and may help identify patients at greater risk of functional decline.