Prevalence of locomotive syndrome and associated factors in patients receiving hemodialysis

Muscle strength and joint and nervous system functions decline with age and in patients undergoing hemodialysis. The Japanese Orthopaedic Association has defined locomotive syndrome (LoS) as a musculoskeletal disorder primarily caused by aging. Therefore, this study aimed to investigate the prevalence of LoS and identify factors associated with its development in patients undergoing hemodialysis. Patients receiving outpatient hemodialysis at Kurume University Hospital were categorized into LoS and non-LoS groups using the cutoff value of 25-question Geriatric Locomotive Function Scale (GLFS-25). We analyzed differences in malnutrition, biochemical examinations, and Kt/V (a measure of dialysis adequacy) between the 2 groups using Wilcoxon rank-sum tests. Additionally, we evaluated factors that correlated with GLFS-25 through pairwise correlations. Multivariate analysis was performed to determine the independent factors associated with LoS. Nineteen patients were included. The median GLFS-25 score was 18. The LoS group (n = 11) had a significantly higher age (P = .0056) and chloride levels than the non-LoS group (n = 8) (P = .0175). Furthermore, the Nutritional Risk Index for Japanese Hemodialysis patients, creatinine levels, and Kt/V were significantly lower in the LoS group than in the non-LoS group (P = .0156, .0026, and .0163, respectively). The GLFS-25 showed significant correlations with age, total protein levels, C-reactive protein, chloride, creatinine, Nutritional Risk Index for Japanese Hemodialysis patients, and Kt/V (with correlation coefficients of -0.6133, -0.4779, 0.4738, 0.5381, -0.7923, 0.6508, and 0.5747, respectively). Multivariate analysis identified life-space assessment (odds ratio [OR], 3.06; 95% confidence interval [CI], -676 to 674; P < .0001) and age (OR, 31.29; 95% CI, -2061 to 2067; P = .0007) as risk factors for LoS. Age and physical activity were found to be associated with the development of LoS in patients with end-stage renal disease undergoing outpatient hemodialysis at our hospital. This emphasizes the importance of implementing preventative measures for LoS, especially for older and less physically active patients.