Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study.
Gait Speed and Mortality, Hospitalization, and Functional Status Change Among Hemodialysis Patients: A US Renal Data System Special Study.
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DOI：
10.1053/j.ajkd.2015.01.024
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发表时间：
2015-08
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通讯作者：
Painter P
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作者：
Kutner NG;Zhang R;Huang Y;Painter P
慢走(步态)速度预示着老年人群中的功能衰退、住院和死亡风险。需要一个关于透析患者预后的步速证据基础。前瞻性队列研究。在USRDS的一项特别研究中，752名年龄在20-92岁的普遍存在的血液透析(HD)患者在7个亚特兰大和7个旧金山的诊所评估了2009-2012年。通常步行速度以米/秒为单位，分类为0.6m/S或更快(基线n=575)，0.6m/S(基线n=94)，不能进行步行试验(基线n=83)。生存；住院；日常生活能力(ADL)困难；SF-36身体功能(PF)。COX比例风险模型调查了703天的中位随访期内的步态速度和死亡率。多变量Logistic或线性回归模型估计了基线步速与住院时间、ADL辅助需求以及12个月后SF-36PF评分之间的关系。步行0.6m/S或以上者死亡53例(9%)，步行+0.6m/S者19例(20%)，不能行走者37例(44%)。与步行0.6m/S或更快的参与者相比，步行+0.6m/S的参与者调整后的死亡风险比为2.17(95%CI，1.19-3.98)，不能行走的参与者的调整后死亡风险比为6.93(95%CI，4.01-11.96)。12个月后，与基线步行速度1.0m/S或更快(n=169)相比，基线步行速度0.6~0.8m/S(n=116)与住院几率(OR，2.04；95%CI，1.19~3.49)、日常生活能力障碍(OR，3.88；95%CI，1.46~10.33)及SF-36 PF评分的−8.20(95%CI，−13.57~−2.82)相关。队列不能很好地代表美国中心内HD人群的总体情况。结论：由于步行对心脏、肺、循环系统、神经和肌肉骨骼系统构成挑战，步态速度提供了一个健康状况的信息标志。步态速度与HD患者功能衰退风险的关系值得继续研究。
Slow walk (gait) speed predicts functional decline, institutionalization and mortality risks in the geriatric population. A gait speed evidence base for dialysis patient outcomes is needed. Prospective cohort study. 752 prevalent hemodialysis (HD) patients aged 20–92 evaluated 2009–2012 in 7 Atlanta and 7 San Francisco clinics in a USRDS special study. Usual walk speed in meters per second, categorized as 0.6 m/s or faster (baseline n=575), <0.6 m/s (baseline n=94), and unable to perform walk test (baseline n=83). Survival; hospitalization; Activities of Daily Living (ADL) difficulty; SF-36 physical function (PF). Cox proportional hazards models investigated gait speed and mortality over a median follow-up of 703 days. Multivariable logistic or linear regression models estimated associations of baseline gait speed with hospitalization, need for ADL assistance, and SF-36 PF score after 12-months. Participants who walked 0.6 m/s or faster had 53 (9%) deaths, those who walked <0.6 m/s had 19 (20%) deaths, and those unable to walk had 37 (44%) deaths. Adjusted mortality hazard ratios were 2.17 (95% CI, 1.19–3.98) for participants who walked <0.6 m/s and 6.93 (95% CI, 4.01–11.96) for those unable to walk, compared with participants walking 0.6 m/s or faster. After 12 months, compared with baseline walk speed 1.0 m/s or faster (n=169 participants), baseline walk speed 0.6 to <0.8 m/s (n=116) was associated with increased odds of hospitalization (OR, 2.04; 95% CI, 1.19–3.49) and ADL difficulty (OR, 3.88; 95% CI, 1.46–10.33) and with a −8.20 (95% CI, −13.57 to −2.82) estimated change in SF-36 PF score. Cohort not highly representative of overall US in-center HD population. Conclusions: Because walking challenges the heart, lungs, circulatory, nervous, and musculoskeletal systems, gait speed provides an informative marker of health status. The association of gait speed with HD patients’ risk for functional decline warrants continued study.