Physical Performance and Risk of Heart Failure, Kidney Failure, and Mortality in CKD

Background: Physical performance limitations are common in chronic kidney disease (CKD) and affect independence and survival, yet physical performance is not routinely assessed. We examined whether the Short Physical Performance Battery (SPPB), a multidimensional measure of lower-extremity physical performance, was longitudinally associated with incident heart failure, kidney failure, and mortality. Methods: We evaluated Chronic Renal Insufficiency Cohort (CRIC) Study participants with ≥1 SPPB assessment, administered approximately every 2-3 years. SPPB was modeled per 1-point lower score, and categorically as low (0–6), moderate (7–9), and high (10–12) performance. Associations of baseline and time-updated SPPB with incident heart failure, incident kidney failure and mortality were evaluated using cause-specific Cox models adjusted for demographic and clinical characteristics. Results: Among 3,038 participants, mean age was 63.5 years, 40% were non-Hispanic Black, and mean estimated glomerular filtration rate (eGFR) was 52 mL/min/1.73m 2 . Median follow-up was 8.5 years, and median baseline SPPB was 10 (8-11). Each 1-point lower baseline SPPB score was associated with 14% higher mortality risk but was not heart failure or kidney failure after full adjustment. In time-updated analyses, each 1-point lower SPPB was associated with a 10% higher heart failure risk and a 15% higher mortality risk. Low and moderate (vs high) SPPB performance categories were associated with 51% and 128% higher heart failure risk and 69% and 224% higher mortality risk, respectively. In contrast, neither baseline nor time-updated SPPB was independently associated with kidney failure. Conclusions: Lower longitudinal physical performance was independently associated with higher risks of heart failure and mortality, but not kidney failure, among adults with CKD. The SPPB may help risk-stratify patients with CKD identifying those at high-risk for cardiovascular outcomes and mortality.