Abstract: FR-PO902
Gait Speed and Mortality in Older Adults with CKD: The Chronic Renal Insufficiency Cohort
Session Information
- Geriatric Nephrology
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Liu, Christine, Stanford University, Stanford, California, United States
- Parvathinathan, Gomathy, Stanford University, Stanford, California, United States
- Stedman, Margaret R., Stanford University, Stanford, California, United States
- Seliger, Stephen L., University of Maryland School of Medicine, Baltimore, Maryland, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
- Tamura, Manjula, Stanford University, Stanford, California, United States
Group or Team Name
- CRIC Study Investigators.
Background
Current models to predict mortality in older persons with CKD use only demographic, kidney, and medical history data. Yet prior work shows impaired physical function independently and strongly predicts death in older adults. ,We assessed if a measure of physical function, gait (walking) speed, improves mortality prediction for older adults with CKD.
Methods
We included Chronic Renal Insufficiency Cohort participants who were ≥65 years with eGFR <60 mL/min/1.73m2, not receiving kidney replacement therapy, non-missing UACR, and with at least 1 gait speed assessment. Gait speed at usual pace on a 4.57 meter course was timed and then categorized (≥ 0.84 meters/second, 0.83 to 0.65, 0.64 to 0.47, ≤ 0.46, or unable to do). We designated the visit with gait speed measurement as baseline. Our primary outcome was time to all-cause death. We used a flexible parametric modeling approach with kidney replacement therapy as a competing risk, adjusting for age, sex, race, eGFR, UACR, smoking, diabetes, heart failure and stroke. C statistics were used to compare models with and without gait speed as a predictor.
Results
Among 2,345 persons, mean age was 70.0±4.4 years; 43% were female and 41% Black. Mean eGFR was 43.3±12.5 mL/min/1.73m2 and median UACR was 33.8 (IQR 9.3-283.4). At baseline, 80% had a gait speed ≤ 0.83 m/s. Over 5 years, 393 persons died, and 164 had kidney failure. For those that died, median survival time was 2.6 years. In time-to-event analyses, slower gait speeds correlated with greater mortality (Figure). After adjustment, the inclusion of gait speed as a predictor improved model performance with the c statistic improving from 0.625 (95% CI 0.624-0.627) to 0.736 (95% CI 0.735-0.737).
Conclusion
In older adults with CKD, we found that gait speed improves mortality prediction. Clinicians should consider assessing gait speed when discussing life expectancy and goals of care with older adults with CKD.
Figure: Kaplan Meier curve of gait speed and all-cause mortality, censoring for kidney failure
Funding
- NIDDK Support