Zhang Xin, Wang Hao, Lu Heyang, Fan Min, Tian Weizhong, Wang Yingzhe, Cui Mei, Jiang Yanfeng, Suo Chen, Zhang Tiejun, Jin Li, Xu Kelin, Chen Xingdong
School of Public Health, The Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China.
Fudan University Taizhou Institute of Health Sciences, Taizhou, Jiangsu, China.
Heliyon. 2024 Aug 3;10(15):e35292. doi: 10.1016/j.heliyon.2024.e35292. eCollection 2024 Aug 15.
Poor gait performance results in more fall incidents among people with chronic kidney disease (CKD). It is unknown what specific quantitative gait markers contribute to high fall risk in CKD and the size of their mediation effects.
We included 634 participants from the Taizhou Imaging Study who had complete gait and laboratory data. Quantitative gait assessment was conducted with a wearable insole-like device. Factor analysis was utilized to summarize fifteen highly correlated individual parameters into five independent gait domains. Prevalent CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m, which was calculated based on cystatin C. Regression models were created to examine the associations of prevalent CKD with quantitative gait markers and the TUG time. Mediation analysis was used to investigate whether poor quantitative gait parameters could be mediators and the proportion of their mediation effects.
Participants with prevalent CKD had a higher TUG time (odds ratio = 2.02, = 0.025) and poor gait performance in the phase domain (standardized β = -0.391, FDR = 0.009), including less time in the swing phase (standardized β = -0.365, FDR = 0.027) and greater time in the double-support phase (standardized β = 0.367, FDR = 0.027). These abnormalities mediated the association of prevalent CKD with a high TUG time (for the swing phase: 31.6 %, = 0.044; for the double-support phase: 29.6 %, = 0.042; for the phase domain: 26.9 %, = 0.048).
Poor phase-related gait abnormalities mediated the relationship between CKD and a high TUG time, suggesting that incorporating quantitative gait markers in specific domains may improve fall prevention programs for individuals with CKD.
步态表现不佳会导致慢性肾脏病（CKD）患者发生更多跌倒事件。目前尚不清楚哪些特定的定量步态指标会导致CKD患者跌倒风险增加及其中介效应的大小。
我们纳入了泰州影像研究中的634名参与者，他们拥有完整的步态和实验室数据。使用一种类似可穿戴鞋垫的设备进行定量步态评估。采用因子分析将15个高度相关的个体参数归纳为5个独立的步态领域。将估算肾小球滤过率（eGFR）<60 ml/min per 1.73 m定义为CKD，该值基于胱抑素C计算得出。建立回归模型以检验CKD患病率与定量步态指标和定时起立行走试验（TUG）时间之间的关联。采用中介分析来研究不良的定量步态参数是否可能为中介因素及其中介效应的比例。
CKD患病率较高的参与者TUG时间更长（优势比=2.02，P=0.025），且在相位领域的步态表现较差（标准化β=-0.391，FDR=0.009），包括摆动相时间减少（标准化β=-0.365，FDR=0.027）和双支撑相时间增加（标准化β=0.367，FDR=0.027）。这些异常介导了CKD患病率与高TUG时间之间的关联（摆动相：31.6%，P=0.044；双支撑相：29.6%，P=0.042；相位领域：26.9%，P=0.048）。
与相位相关的不良步态异常介导了CKD与高TUG时间之间的关系，这表明纳入特定领域的定量步态指标可能会改善CKD患者的跌倒预防方案。
