Gait abnormalities and longitudinal fall risk in older patients with end-stage kidney disease and sarcopenia

Abstract

Background: Sarcopenia, gait disturbance, and intradialytic hypotension are among the various factors that contribute to fall risk. This study aimed to investigate the relationship between risk of sarcopenia, hemodialysis (HD) session, and long-term fall risk in older end-stage kidney disease (ESKD) patients by analyzing their spatiotemporal gait characteristics.

Methods: We recruited 22 non-demented patients aged ≥ 65 years who were undergoing maintenance HD. Participants were divided into two groups based on their SARC-F score (< 4 and ≥ 4) to identify those with higher and lower risk of sarcopenia. Demographics, comorbidities, and renal parameters were compared between groups. Inertial measurement unit-based technology equipped with triaxial accelerometry and gyroscope was used to evaluate gait characteristics. The gait task was assessed both before and after dialysis using the Timed-Up and Go (TUG) test and a 10-meter walking test at a regular pace. Essential gait parameters were thoroughly analyzed, including gait speed, stride time, stride length, double-support phase, stability, and symmetry. We investigated the interaction between the dialysis procedure and gait components. Outcome of interest was any occurrence of injurious fall during follow-up period. Logistic regression models were employed to examine the relationship between baseline gait markers and long-term fall risk.

Results: The SARC-F ≥ 4 group showed various gait abnormalities, including longer TUG time, slower gait speed, longer stride time, shorter stride length, and longer double support time compared to counterpart (SARC-F < 4). After HD sessions, the SARC-F ≥ 4 group showed a 2.0-second decrease in TUG task time, an 8.0 cm/s increase in gait speed, an 11.6% lower stride time, and a 2.4% increase in gait symmetry with significant group-time interactions. Shorter stride length and longer double support time were associated with injurious falls during the two-year follow-up.

Conclusion: Our study demonstrated the utility of triaxial accelerometers in extracting gait characteristics in older HD patients. High-risk sarcopenia (SARC-F ≥ 4) was associated with various gait abnormalities, some of which partially improved after HD sessions. These gait abnormalities were predictive of future falls, highlighting their prognostic significance.

Keywords: Fall; Hemodialysis; Older; Sarcopenia; Triaxial accelerometry.

Fig. 1

Schematic representation of gait evaluation in older HD patients. SARC-F, strength, ambulation, rising from a chair, stair climbing and history of falling; HD, hemodialysis

Fig. 2

Diagram illustration of procedure for signal conditioning and example of gyroscope and accelerometer signals of a sample subject (IMU located at ankle). IMU, inertial measurement unit; MCU, microcontroller unit

Fig. 3

Example of acceleration (acc) measured by the accelerometer of a sample subject from 5 strides of left lower extremity

Fig. 4

Prevalence of SARC-F components in older HD patients. SARC-F, strength, ambulation, rising from a chair, stair climbing and history of falling; HD, hemodialysis

Fig. 5

Changes of gait parameters in comparison of pre- and post-HD status between different risk groups of sarcopenia (Dark line indicates SARC-F ≥ 4 group, white line indicates SARC-F < 4 group). (A) Timed-Up and Go (interaction p < 0.001), (B) Gait speed (interaction p = 0.003), (C) Stride time (interaction p = 0.024), (D) Symmetry (interaction p = 0.005). HD, hemodialysis; SARC-F, strength, ambulation, rising from a chair, stair climbing and history of falling