Chronic Kidney Disease and Functional Limitation in Older People: Health, Aging and Body Composition Study

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Abstract

OBJECTIVES

To assess whether chronic kidney disease (CKD) is independently associated with incident physical-function limitation.

DESIGN

Prospective cohort study.

SETTING

Two sites: Pittsburgh, Pennsylvania, and Memphis, Tennessee.

PARTICIPANTS

Two thousand one hundred thirty-five men and women aged 70 to 79 without functional limitation at baseline from the Health, Aging and Body Composition Study.

MEASUREMENTS

Functional limitation was defined as difficulty in walking one-quarter of a mile or climbing 10 steps on two consecutive reports 6 months apart (in the same function). Kidney function was measured using serum cystatin C. Estimated glomerular filtration rate (eGFR), using the Modification of Diet in Renal Disease formula (<60 versus ≥60 mL/min per 1.73 m2), was a secondary predictor. Muscle strength, lean body mass according to dual energy x-ray absorptiometry, comorbidity, medication use, and inflammatory markers were evaluated as covariates.

RESULTS

Persons in the highest (≥1.13 mg/L) quartile of cystatin C experienced a significantly higher risk of developing functional limitation than those in the lowest (<0.86 mg/L) quartile (hazard ratio (HR)=1.70, 95% confidence interval (CI)=1.40–2.07). The association between the fourth cystatin C quartile and functional limitation remained after adjustment for demographics, lean body mass, comorbidity, muscle strength, and gait speed (HR=1.41, 95% CI=1.13–1.75), although the association was attenuated after adjustment for markers of inflammation (HR=1.15, 95% CI=0.90–1.46). Similar results were found for eGFR less than 60 mL/min per 1.73 m2, although the association with functional limitation remained after adjustment for inflammatory markers (HR=1.30, 95% CI=1.08–1.56).

CONCLUSION

CKD is associated with the development of functional impairment independent of comorbidity, body composition, and tests of strength and physical performance. The mechanism may be related to a heightened inflammatory state in CKD.

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