SP407INVESTIGATION OF FACTORS AFFECTING LOSS OF WALKING ABILITY IN DIALYSIS PATIENTS BY A FOUR YEAR LONGITUDINAL STUDY

Abstract

INTRODUCTIONAND AIMS: For dialysis patients, muscle strength and physical performance decrease with aging and long-term continuation of dialysis treatment, and it becomes easy to fall into the condition requiring long term care after the frailty. Frailty is reversible and it can be dealt with by appropriate rehabilitation, and the evidence of exercise for dialysis patients has been reported in some papers recently. To perform a dialysis regularly, walking on their own feet is important not only to enhance the quality of life of the patient himself but also to reduce the burden of caregivers and medical institutions staff. In addition, it is important to prevent the decline in walking ability, as it is reported that the amount of physical activity by walking is related to life expectancy. However, once the ability to walk is lost, it is known that acquiring independent walking ability again require a long period and is often difficult. Therefore, the aim of this study is to clarify the factors related to loss of walking ability of dialysis patients. METHOD(S): Of the 179 outpatients undergoing maintenance hemodialysis, 93 patients who were evaluated in both September 2013 (first time) and September 2017 (four years later) were subjects. In patient attributes, age, dialysis period, comorbidity, biochemical data, geriatric nutritional risk index (GNRI) as nutritional status were examined from the medical records. For evaluating physical function, fat free mass, muscle strength, short physical performance battery (SPPB), walking speed were measured by physical therapist. We investigated the factors involved in the loss of walking ability by multiple logistic analysis and ROC analysis with the loss of walking ability as dependent variable and patient attribute and physical function as independent variables. RESULT(S): Seven patients (8%) had lost their walking ability in four years. Factors involved in the loss of walking ability were the first SPPB scores (odds ratio, 0.786; 95% CI, 0.6+/-8-0.982; p= 0.03). In the case the SPPB cutoff value was 8 or less, the odds ratio to loss of walking ability was 10.578 (95% CI, 1.382-80.967; p= 0.02), the sensitivity was 0.714, the specificity was 0.791, and the area under the curve was 0.786 (p = 0.01). CONCLUSION(S): It was suggested that in the situation of the score of SPPB that is an index of simply physical performance falls below the 8 points, there is a high risk of losing walking ability in several years later. We concluded that comprehensive rehabilitation including exercise therapy and fall prevention is preferentially necessary in these patients.