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Original ArticlesGeriatric and Palliative Nephrology
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Walking while Talking in Older Adults with Chronic Kidney Disease

Jim Q. Ho, Joe Verghese and Matthew K. Abramowitz
CJASN May 2020, 15 (5) 665-672; DOI: https://doi.org/10.2215/CJN.12401019
Jim Q. Ho
1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;
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Joe Verghese
1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;
2Department of Neurology, Albert Einstein College of Medicine, Bronx, New York;
3Institute for Aging Research, Albert Einstein College of Medicine, Bronx, New York;
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Matthew K. Abramowitz
1Department of Medicine, Albert Einstein College of Medicine, Bronx, New York;
3Institute for Aging Research, Albert Einstein College of Medicine, Bronx, New York;
4Diabetes Research Center, Albert Einstein College of Medicine, Bronx, New York; and
5Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York
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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.

  • geriatric nephrology
  • Aged
  • Walking Speed
  • Walking
  • Accidental Falls
  • Independent Living
  • Frailty
  • Gait Analysis
  • Factor Analysis
  • Statistical
  • glomerular filtration rate
  • Gait
  • Cognitive Dysfunction
  • Linear Models
  • EGFR protein
  • human
  • ErbB Receptors
  • Renal Insufficiency
  • Chronic
  • Cognition
  • Received October 12, 2019.
  • Accepted February 10, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (5)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 5
May 07, 2020
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Walking while Talking in Older Adults with Chronic Kidney Disease
Jim Q. Ho, Joe Verghese, Matthew K. Abramowitz
CJASN May 2020, 15 (5) 665-672; DOI: 10.2215/CJN.12401019

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Walking while Talking in Older Adults with Chronic Kidney Disease
Jim Q. Ho, Joe Verghese, Matthew K. Abramowitz
CJASN May 2020, 15 (5) 665-672; DOI: 10.2215/CJN.12401019
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Keywords

  • geriatric nephrology
  • aged
  • Walking Speed
  • Walking
  • Accidental Falls
  • Independent Living
  • Frailty
  • Gait Analysis
  • Factor Analysis
  • Statistical
  • glomerular filtration rate
  • Gait
  • Cognitive Dysfunction
  • linear models
  • EGFR protein
  • human
  • ErbB Receptors
  • renal insufficiency
  • chronic
  • Cognition

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