Walking autonomy in chronic dialysis patients: insights from a nationwide registry and focus group analysis.

Background: Patients with chronic kidney disease (CKD) requiring kidney replacement therapy experience a loss in walking autonomy. This study used data from the French Renal Epidemiology and Information Network in Nephrology (REIN) registry and those from the National Health Data System [Système national des Données de Santé (SNDS)] to assess associations between walking inabilities and patient characteristics.

Methods: We extracted data on all patients receiving kidney replacement therapy in France as of 31 December 2020. We used logistic regression to evaluate data associated with walking autonomy. We also created four focus groups to explore the perspectives of dialysis patients with respect to walking autonomy, and conducted a thematic analysis of qualitative data.

Results: Data were available for 50 629 adults undergoing dialysis. Among the remaining 48 243 patients without missing data, 6834 (14%) were identified as having a walking disability, defined as walking with assistance or being totally unable to walk. Walking disabilities were associated with numerous comorbidities after adjustment for age. Despite their limitations, 2117 (46%) patients requiring assistance and 730 (43%) with total inability to walk had not been reimbursed for a mobility aid through the National Health Data System (SNDS). Thematic analysis identified four major themes from the focus groups: difficulties carrying out daily tasks, impact on social life, impact on connection to the body and psychological impact.

Conclusion: Walking disability is strongly associated with patient comorbidities. It impairs quality of life, particularly through psychological and social consequences. Dedicated interventions and improved access to assistive devices are needed to help patients with walking disabilities.