Association between Physical Performance and All-Cause Mortality in CKD
Association between Physical Performance and All-Cause Mortality in CKD
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DOI：
10.1681/asn.2012070702
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发表时间：
2013-05-01
影响因子：
13.6
通讯作者：
Seliger, Stephen
中科院分区：
文献类型：
--
作者：
Roshanravan, Baback;Robinson-Cohen, Cassianne;Seliger, Stephen
在老年人中，体能测量评估身体功能，并与死亡率和残疾有关。CKD常伴有肌肉萎缩和体能减退，类似生理性衰老，但体能是否与CKD的临床转归相关尚不清楚。我们评估了华盛顿大学和马里兰大学和马里兰大学退伍军人事务医疗系统以临床为基础的队列中登记了2-4期CKD的385名无中风的门诊参与者。我们将握力、通常步态速度、计时起跑(TUAG)和6分钟步行距离与标准值进行比较，并构建COX比例风险模型和受试者操作特征曲线，以检验与全因死亡率的相关性。平均年龄61岁，平均估计肾小球滤过率为41ml/min/1.73m(2)。测量的下肢功能至少比预期的低30%，但握力相对保持不变。在中位数3年的随访期内发生了50例死亡。调整后，步态速度每降低0.1m/S，死亡风险增加26%，拖步速度每增加1秒，死亡风险增加8%。根据受试者的操作特征分析，步速和TUAG比肾功能或通常测量的血清生物标志物更能预测3年的死亡率。将步态速度添加到包括估计的GFR的模型中，显著提高了对3年死亡率的预测。综上所述，CKD患者的肢体运动能力受损是很常见的，并且与各种原因的死亡率密切相关。J am Soc Nephrol 24：822-830,2013。DOI：10.1681/ASN.2012070702
In older adults, measurements of physical performance assess physical function and associate with mortality and disability. Muscle wasting and diminished physical performance often accompany CKD, resembling physiologic aging, but whether physical performance associates with clinical outcome in CKD is unknown. We evaluated 385 ambulatory, stroke-free participants with stage 2-4 CKD enrolled in clinic-based cohorts at the University of Washington and University of Maryland and Veterans Affairs Maryland Healthcare systems. We compared handgrip strength, usual gait speed, timed up and go (TUAG), and 6-minute walking distance with normative values and constructed Cox proportional hazards models and receiver operating characteristic curves to test associations with all-cause mortality. Mean age was 61 years and the mean estimated GFR was 41 ml/min per 1.73 m(2). Measures of lower extremity performance were at least 30% lower than predicted, but handgrip strength was relatively preserved. Fifty deaths occurred during the median 3-year follow-up period. After adjustment, each 0.1-m/s decrement in gait speed associated with a 26% higher risk for death, and each 1-second longer TUAG associated with an 8% higher risk for death. On the basis of the receiver operating characteristic analysis, gait speed and TUAG more strongly predicted 3-year mortality than kidney function or commonly measured serum biomarkers. Adding gait speed to a model that included estimated GFR significantly improved the prediction of 3-year mortality. In summary, impaired physical performance of the lower extremities is common in CKD and strongly associates with all-cause mortality. J Am Soc Nephrol 24: 822-830, 2013. doi: 10.1681/ASN.2012070702