Citation

Ho JQ, Verghese J, Abramowitz MK. Clin. J. Am. Soc. Nephrol. 2020; ePub(ePub): ePub.

Affiliation

Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York.

Copyright

(Copyright © 2020, American Society of Nephrology)

DOI

10.2215/CJN.12401019

PMID

32144098

Abstract

BACKGROUND AND OBJECTIVES: Walking while talking is a dual cognitive-motor task that predicts frailty, falls, and cognitive decline in the general elderly population. Adults with CKD have gait abnormalities during usual walking. It is unknown whether they have greater gait abnormalities and cognitive-motor interference during walking while talking. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Community-dwelling, nondisabled adults (n=330) ≥65 years of age underwent quantitative gait analysis, including walking while talking. Differences in walking while talking performance by CKD status were evaluated, and relative changes between walking while talking and walking alone performance were computed to quantify cognitive-motor interference (dual-task cost). Associations were tested using multivariable linear spline regression models, and independent gait domains were derived using factor analysis. CKD was defined as an eGFR<60 ml/min per 1.73 m².

RESULTS: CKD was present in 134 (41%) participants. Participants with CKD had slower gait speed along with various gait cycle abnormalities during walking while talking: among those with CKD, every 10-ml/min per 1.73 m² lower eGFR was associated with 3.3-cm/s (95% confidence interval, 0.4 to 6.1) slower gait speed, 1.8-cm (95% confidence interval, 0.6 to 3.0) shorter step length, 1.1% (95% confidence interval, 0.6 to 1.7) less time in the swing phase, and 1.4% (95% confidence interval, 0.5 to 2.3) greater time in double support after multivariable adjustment. When comparing walking while talking with walking alone, every 10-ml/min per 1.73 m² lower eGFR was associated with 1.8% (95% confidence interval, 0.5 to 3.2) greater decrease in time in the swing phase and 0.9% (95% confidence interval, 0.2 to 1.5) greater increase in time in the stance phase. Factor analysis identified three walking while talking domains and three dual-task cost domains: eGFR was associated specifically with the rhythm domain for both walking while talking and dual-task cost. Every 10-ml/min per 1.73 m² lower eGFR was associated with a poorer performance of 0.2 SD (95% confidence interval, 0.1 to 0.3) for walking while talking and 0.2 SD (95% confidence interval, 0.03 to 0.3) for dual-task cost.

CONCLUSIONS: During walking while talking, CKD is associated with gait abnormalities, possibly due to increased cognitive-motor interference.

Copyright © 2020 by the American Society of Nephrology.

Language: en

Keywords

Accidental Falls; Aged; Chronic; Cognition; Cognitive Dysfunction; EGFR protein; ErbB Receptors; Factor Analysis; Frailty; Gait; Gait Analysis; Independent Living; Linear Models; Renal Insufficiency; Statistical; Walking; Walking Speed; geriatric nephrology; glomerular filtration rate; human