Community Mobility Among Older Adults With Reduced Kidney Function: A Study of Life-Space

• Published in: American journal of kidney diseases Vol. 63; no. 3; pp. 429 - 436
• Main Authors: Bowling, C. Barrett, MD, MSPH, Muntner, Paul, PhD, Sawyer, Patricia, PhD, Sanders, Paul W., MD, Kutner, Nancy, PhD, Kennedy, Richard, MD, PhD, Allman, Richard M., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-03-2014; Elsevier
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Chronic kidney disease; elderly; Female; Follow-Up Studies; Glomerular Filtration Rate - physiology; Humans; Kidneys; life-space mobility; Locomotion - physiology; Male; Medical sciences; Mobility Limitation; Nephrology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Prospective Studies; Renal failure; Renal Insufficiency - physiopathology; Time Factors; Urinary system involvement in other diseases. Miscellaneous; elderly; Chronic kidney disease; life-space mobility; Human; Kidney disease; Nephrology; Urinary system disease; Renal function; Mobility; Urology; Renal failure; Adult; Elderly; Age; Community
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2013.07.022

Background Life-Space Assessment captures community mobility and social participation and quantifies the distance, frequency, and independence obtained as an older adult moves through his or her environment. Reduced estimated glomerular filtration rate (eGFR) is associated with decline in activities of daily living among older adults, but less is known about the association of eGFR with restrictions in mobility. Study Design Prospective observational cohort study. Setting & Participants Community-dwelling Medicare beneficiaries from the University of Alabama at Birmingham Study of Aging who had serum creatinine measured during a baseline in-home study visit and completed at least one telephone follow-up (N = 390). Predictor eGFR ≥ 60, 45-59, and <45 mL/min/1.73 m2. Outcome Life-space mobility trajectory. Measurements Life-space mobility was evaluated by telephone every 6 months for up to 4.5 years using the previously validated Life-Space Assessment. Scores using this tool range from 0-120 (higher scores indicate greater mobility). Results Mean age of the 390 participants was 77.6 ± 5.8 (SD) years, 41% were African American, 50.5% were women; 30.0% had eGFR of 45-59 mL/min/1.73 m2 , and 20.2% had eGFR < 45 mL/min/1.73 m2 . Age-, race-, and sex-adjusted mean baseline life-space mobility scores were 64.8 (95% CI, 62.0-67.6), 63.8 (95% CI, 60.3-67.4), and 58.3 (95% CI, 53.8-62.7) among those with eGFR categories ≥ 60, 45-59, and <45 mL/min/1.73 m2 , respectively. Compared with those with eGFRs ≥ 60 mL/min/1.73 m2 , a more rapid decline in life-space mobility was found among those with eGFRs < 45 mL/min/1.73 m2 , though this did not reach statistical significance ( P = 0.06); a similar effect was not seen among those with eGFRs of 45-59 mL/min/1.73 m2 ( P = 0.3). Limitations Urinary albumin or longitudinal measures of eGFR were not available. Conclusions eGFR < 45 mL/min/1.73 m2 was associated with a trend toward a more rapid decline in life-space mobility among community-dwelling older adults. Findings should be confirmed in a larger population.