Gait Speed as a Crucial Independent Predictor of Mortality and Cardiovascular Risk in Patients on Maintenance Hemodialysis

Background: Low gait speed is an important criterion for diagnosing sarcopenia, which is prevalent in maintenance hemodialysis (MHD) patients. This prospective cohort study evaluated the impact of sarcopenia on myocardial structure and function, survival, hospitalization, and cardiovascular events (CVE) in MHD patients. Methods: Participants were derived from a single dialysis center. Skeletal muscle mass, handgrip strength, gait speed (GS), and echocardiography were assessed. GS is measured by a 6-minute walk test. Lower gait speed was defined at ＜0.8m/s. The primary endpoints were CVE, hospitalization, and all-cause mortality. Results: We studied 307 participants, 46 (15.0%) with lower gait speed. Participants with lower gait speed were characterized by older age (68.1±9.8 years vs. 57.2±12.3 years, P<0.001) and a higher prevalence of diabetes (12.8% vs. 33.1%, P<0.001). Participants with lower gait speed had higher left ventricular posterior wall (12.33±0.93 vs 12.09±0.98 mm, P=0.040), higher interventricular septum thickness (13.36±1.07 vs 13.10±1.06 mm, P=0.037), higher right ventricular wall (10.28±1.12 vs 9.79±1.12 mm, P<0.001), and faster tricuspid valve regurgitation velocity (1.51±0.79 vs 1.19±0.50 cm/s, P=0.001). Lower gait speed participants also had higher left ventricular mass index (129.2±27.6 vs 120.7±23.9, P=0.005), a higher proportion of right ventricular diastolic dysfunction (60.0% vs 35.8%, P=0.016), and a higher proportion of valve calcification (57.9% vs 34.9%, P=0.006). Lower gait speed was strongly negatively correlated with left ventricular mass (LVM) (r =-0.273, P< 0.001). Within 24 months of followup, gait speed was independently predicted CVE (adjusted hazard ratio (HR)=0.402; 95% CI [0.190–0.850]; P=0.017), hospitalization (HR=0.316; 95% CI [0.193–0.518]; P<0.001), and all-cause mortality (HR=0.082; 95% CI [0.028–0.244]; P<0.001). Conclusion: Gait speed is associated with left ventricular mass and right ventricular dysfunction in MHD patients. Gait speed is an independent predictor of all-cause mortality, hospitalization, and cardiovascular risk in Maintenance Hemodialysis Patients. Funding: Government Support – Non-U.S.