Background. Gait disturbance is proposed as a mechanism for higher risk of fall in kidney disease patients. We investigated the association of kidney function with gait pattern in the general population and tested whether the association between impaired kidney function and fall is more pronounced in subjects with lower gait function. Methods. We included 1430 participants (mean age: 60 years) from the Rotterdam Study. Kidney function was assessed using estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR). We assessed global gait, gait velocity and seven independent gait domains: Rhythm, Phases, Variability, Pace, Tandem, Turning and Base of Support. Regression models adjusted for cardiometabolic and neurological factors were used. We evaluated whether participants with impaired kidney function and impaired gait fell more in the previous year. Results. The study population had a median (interquartile range) ACR of 3.6 (2.5-6.2) mg/g and mean 6 SD eGFR of 87.6 6 15 mL/min/1.73 m2. Higher ACR and lower eGFR were associated with lower global gait score [per doubling of ACR: 0.10, 95% confidence interval (CI): 0.14 to 0.06, and per SD eGFR:0.09, 95% CI: 0.14 to 0.03] and slower gait speed (ACR: 1.44 cm/s, CI: 2.12 to 0.76; eGFR: 1.55 cm/s, CI: 2.43 to 0.67). Worse kidney function was associated with lower scores in Variability domain. The association between impaired kidney function and history of fall was present only in participants with lower gait scores [odds ratio (95% CI): ACR: 1.34 (1.09-1.65); eGFR: 1.58 (1.07-2.33)]. Conclusions. We observed a graded association between lower kidney function and impaired gait suggesting that individuals with decreased kidney function, even at an early stage, need to be evaluated for gait abnormalities and might benefit from fall prevention programmes.
Bibliographical noteFunding Information:
The Rotterdam Study is supported by the Erasmus Medical Center and Erasmus University Rotterdam; the Netherlands Organization for Scientific Research; the Netherlands Organization for Health Research and Development (ZonMw); the Research Institute for Diseases in the Elderly; the Ministry of Education, Culture and Science; the Ministry of Health, Welfare and Sports; the European Commission; and the Municipality of Rotterdam. J.N.v.d.G. was supported by the Prinses Beatrix Fonds. Funding for gait assessment was obtained from the International Parkinson Fonds. O.H.F. works in ErasmusAGE, a centre for ageing research across the life course funded by Nestlé Nutrition (Nestec Ltd), Metagenics Inc. and AXA. The sponsors had no involvement in any of the following: the study design; the collection, analysis and interpretation of data; the writing of the manuscript; and the decision to submit the manuscript for publication.
© The Author(s) 2018. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
- Albumin-to-creatinine ratio
- Gait speed
- Glomerular filtration rate