The prognostic value of gait speed in hemodialysis patients: A prospective observational study

Abstract

Background Gait speed has emerged as a sensitive and practical measure of functional status, and its association with overall health and adverse outcomes in various populations has been increasingly recognized. However, its prognostic value among hemodialysis patients remains insufficiently explored. Objective To assess the prognostic value of the gait speed in hemodialysis patients. Methods This prospective observational study assessed adults with end-stage renal disease on hemodialysis. Baseline measurements were taken from April 2019 onward, and survival was observed until December 2024. Usual walking speed was measured by an 8-meter gait speed protocol, with the time to cover the central 4-meter distance recorded. Also, established prognostic factors were evaluated. Data were analyzed using the Cox regression analysis and the ROC curve. The Kaplan-Meier curve compared the cumulative survival across gait speed categories. Statistical significance was set at 5%. Results A total of 120 eligible patients were included. Age (HR 1.05 [95% CI 1.01–1.09], p = 0.01), phosphorus (HR 0.72 [95% CI 0.54–0.96], p = 0.03), and gait speed (HR 0.04 [95% CI 0.01–0.14], p < 0.0001) were associated with mortality. Gait speed (HR 0.04 [95% CI 0.01–0.15], p < 0.0001) was an independent predictor of mortality. The optimal cutoff point for mortality risk identification was ≥ 1.13 m/s (AUC = 0.85 [0.77–0.0.90]; p < 0.0001), and low mobility was associated with a 10.4-fold higher mortality risk (HR 10.49 [95% CI 3.70–29.96], p < 0.0001). Conclusion Gait speed presented excellent accuracy in mortality risk identification, and low mobility was a significant risk factor for death in individuals undergoing hemodialysis. These findings highlight that gait speed assessment, a simple, quick, and low-cost measure, can be implemented in dialysis centers for risk stratification, supporting more targeted clinical decisions and therapeutic approaches. Furthermore, they underscore the importance of functional assessment in this setting.