Background Patients with chronic kidney disease commonly experience gait abnormalities, which predispose to falls and fall-related injuries. An unmet need is the development of improved methods for detecting patients at high risk of these complications, using tools that are feasible to implement in nephrology practice. Our prior work suggested step length could be such a marker. Here we explored the use of step length as a marker of gait impairment and fall risk in adults with chronic kidney disease. Methods We performed gait assessments in 2 prospective studies of 82 patients with stage 4 and 5 chronic kidney disease (n = 33) or end-stage renal disease (ESRD) (n = 49). Gait speed and step length were evaluated during the 4-m walk component of the Short Physical Performance Battery (SPPB). Falls within 6 months prior to or following enrollment were identified by questionnaire. Associations of low step length (≤47.2 cm) and slow gait speed (≤0.8 m/s) with falls were examined using logistic regression models adjusted for demographics and diabetes and peripheral vascular disease status. Results Assessments of step length were highly reproducible (r = 0.88, p < 0.001 for duplicate measurements at the same visit; r = 0.78, p < 0.001 between baseline and 3-month evaluations). Patients with low step length had poorer physical function, including lower SPPB scores, slower gait speed, and lower handgrip strength. Although step length and gait speed were highly correlated (r = 0.73, p < 0.001), one-third (n = 14/43) of patients with low step length did not have slow gait speed. Low step length and slow gait speed were each independently associated with the likelihood of falls (odds ratio (OR) 3.90 (95% confidence interval (CI) 1.05–14.60) and OR 4.25 (95% CI 1.24–14.58), respectively). Compared with patients who exhibited neither deficit, those with both had a 6.55 (95% CI 1.40–30.71) times higher likelihood of falls, and the number of deficits was associated with a graded association with falls (p trend = 0.02). Effect estimates were similar after further adjustment for ESRD status. Conclusions Step length and gait speed may contribute additively to the assessment of fall risk in a general adult nephrology population.
Background: Physical inactivity is common in patients receiving hemodialysis, but activity patterns throughout the day and in relation to dialysis are largely unknown. This knowledge gap can be addressed by long-term, continuous activity monitoring, but this has not been attempted and may not be acceptable to dialysis patients. Methods: Ambulatory patients with end-stage kidney disease receiving thrice-weekly hemodialysis wore commercially available wrist-worn activity monitors for 6 months. Step counts were collected every 15 minutes and were linked to dialysis treatments. Physical function was assessed using the Short Physical Performance Battery (SPPB). Fast time to recovery from dialysis was defined as ≤2 hours. Mixed effects models were created to estimate step counts over time. Results: Of 52 patients enrolled, 48 were included in the final cohort. The mean age was 60 years, and 75% were Black or Hispanic. Comorbidity burden was high, 38% were transported to and from dialysis by paratransit, and 79% had SPPB <10. Median accelerometer use (199 days) and adherence (95%) were high. 42 patients (of 43 responders) reported wearing the accelerometer every day, and few barriers to adherence were noted. Step counts were lower on dialysis days (3991 (95% CI 3187-4796) vs. 4561 (95% CI 3757-5365)), but step count intensity was significantly higher during the hour immediately following dialysis than during the corresponding time on non-dialysis days (188 steps/hour increase (95% CI 171-205)); these levels were the highest noted at any time. Post-dialysis increases were more pronounced among patients with fast recovery time (225 (95% CI 203-248) vs. 134 (95% CI 107-161) steps/hour) or those with SPPB≥7. Estimates were unchanged after adjustment for demographics, diabetes status, and ultrafiltration rate. Conclusions: Long-term, continuous monitoring of physical activity is feasible in hemodialysis patients. Highly granular data collection and analysis yielded new insights into patterns of activity following dialysis treatments.
BackgroundSystemic lupus erythematosus (SLE) patients can present to emergency department (ED) with acute manifestations that require immediate evaluation and initiation of appropriate therapy. The reasons for ED visits could be due to disease activity or various complications arising due to therapy. However, there is paucity of data on the reasons and outcomes of SLE patients who present to ED.ObjectivesTo determine the reason, 3 month outcomes and the predictors of mortality among the SLE patients who present to ED.MethodsSingle centre prospective observational study was being performed between July 2021 and December 2022. Patients of SLE fulfilling the SLICC or the 2019 ACR/EULAR classification criteria and aged above 18 years and presenting to ED were included. Written informed consent was obtained from all the subjects. Clinical and laboratory details were noted at the time of presentation to ED. The reasons for ED visits were classified into disease activity or infection or both or non-SLE related. Outcomes of death and disease activity (by SLEDAI2K) at 3 months were noted. The study was approved by the Institute Ethics Committee.ResultsA total of 61 patients were included in the study. Median age was 28 years (IQR: 24-35) and 55 (90.2%) were females. Twenty (32.8%) patients were newly diagnosed with SLE after presentation to ED, and the median duration of illness among previously diagnosed patients was 24 months (IQR: 12-48). Disease activity alone (n=41; 67.2%) was the commonest reason for ED visit followed by disease activity co-existing with infection (n=15; 24.6%) and infections alone (n=5; 8.2%). Among the 56 patients with disease activity at presentation, active disease manifestations were noted in following organs: renal (57.1%), musculoskeletal (53.6%), skin (51.8%), haematological (42.9%), serositis (39.3%), neurological (28.6%), cardiac (26.8%), gastrointestinal (14.3%) and lung (5.4%). Among the 20 patients with infections at presentation, lower respiratory tract infections were the commonest, seen in 7 (35%) patients followed by CNS infections (15%). UTI, skin and soft tissue, ear and sino-nasal and sepsis with un-identified focus were seen in 2 (10%) patients each. Infective colitis and bacterial peritonitis were identified in 1 (5%) patient each. At 3 months of follow up, 21 (34.4%) patients died, with majority (n=18; 85.7%) dying within 1 month of presentation. Deaths were significantly more in patients who presented with both disease activity and infection compared to patients who presented with only disease activity or infection (p=0.0001). Among the remaining 40 patients, 15 (37.5%) were in remission, 13 (32.5%) were in low disease activity and 12 (30%) were in moderate to high disease activity. On multiple regression analysis, presence of hypoxia (p=0.046), serum albumin less than 2.5g/dl (p=0.006) and infection (p=0.001) at presentation predicted mortality at three months (Table 1).ConclusionThe commonest cause of ED visit by SLE patients is disease activity alone followed by disease activity and co-existing infections. Infections were present at the time of ED admission in one-third of SLE patients. Three month mortality rate was high (34.4%) and presence of hypoxia, low serum albumin and infection at presentation predicted mortality at three months.Table 1.Multiple regression analysis for prediction of mortality.Parameterp valueGender0.164New onset disease0.646Hypotension at presentation0.074Hypoxia at presentation0.046Severe anaemia0.386Low complements0.179Serum creatinine >1.5mg/dl0.451Serum albumin <2.5 g/dl0.006Renal involvement0.359Need of haemodialysis at presentation0.527Myocarditis0.112Diffuse alveolar haemorrhage0.092Haematological involvement0.557Neurological involvement0.333Enteritis0.119Serositis0.721Infections at presentation0.001REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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