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Open AccessArticle

Hemodialysis Impact on Motor Function beyond Aging and Diabetes—Objectively Assessing Gait and Balance by Wearable Technology

1
Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA
2
Fahad Bin Jassim Kidney Center, Department of Nephrology, Hamad General Hospital, PO Box 3050 Doha, Qatar
3
Diabetic Foot and Wound Clinic, Hamad Medical Co, PO Box 3050 Doha, Qatar
*
Author to whom correspondence should be addressed.
Sensors 2018, 18(11), 3939; https://doi.org/10.3390/s18113939
Received: 26 September 2018 / Revised: 25 October 2018 / Accepted: 9 November 2018 / Published: 14 November 2018
(This article belongs to the Special Issue Sensors to Manage Chronic Complications)
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PDF [2963 KB, uploaded 14 November 2018]
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Abstract

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. This study examined whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48–64 years) and older adults (65+ years). One hundred and ninety-six subjects (age = 66.2 ± 9.1 years, body-mass-index = 30.1 ± 6.4 kg/m2, female = 56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n = 38) and without HD (Mid-age HD−, n = 40); older adults with diabetes undergoing HD (Older HD+, n = 36) and without HD (Older HD−, n = 37); and non-diabetic older adults (Older DM−, n = 45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p < 0.050). Among people with diabetes, HD+ had significantly worsened gait and balance when comparing to HD− (Cohen’s effect size d = 0.63–2.32, p < 0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d = 2.32, p < 0.001). Results suggested that deterioration in normalized gait speed among HD+ was negatively correlated with age (r = −0.404, p < 0.001), while this correlation was diminished among HD−. Interestingly, results also suggested that poor gait among Older HD− is related to poor ankle stability, while no correlation was observed between poor ankle stability and poor gait among Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among HD− people with diabetes, poor ankle stability described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visit. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention. View Full-Text
Keywords: hemodialysis; end stage renal disease; diabetes; motor performance; gait; balance; wearables; aging; frailty; diabetic peripheral neuropathy; falls hemodialysis; end stage renal disease; diabetes; motor performance; gait; balance; wearables; aging; frailty; diabetic peripheral neuropathy; falls
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MDPI and ACS Style

Zhou, H.; Al-Ali, F.; Rahemi, H.; Kulkarni, N.; Hamad, A.; Ibrahim, R.; Talal, T.K.; Najafi, B. Hemodialysis Impact on Motor Function beyond Aging and Diabetes—Objectively Assessing Gait and Balance by Wearable Technology. Sensors 2018, 18, 3939.

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