Tests of neuromuscular function are associated with fractures in patients with chronic kidney disease

Nephrol Dial Transplant. 2012 Jun;27(6):2384-8. doi: 10.1093/ndt/gfr620. Epub 2011 Nov 18.


Background: Fractures are common in individuals with chronic kidney disease (CKD), and tests of neuromuscular function (NMT) discriminate well among fractured and non-fractured patients with Stage 5 CKD on dialysis. The ability of NMT to discriminate fracture status in patients with Stages 3-5 CKD is unknown.

Methods: In this cross-sectional study, we sought to determine in adult patients with Stages 3-5 CKD (eGFR by the Modification of Diet in Renal Disease equation) if NMT [timed up and go (TUG), 6-min walk (6MW) and grip strength] could discriminate fracture status (self-reported low-trauma fractures since age 40 and/or vertebral fractures by morphometry). We conducted logistic regression and receiver-operating characteristic (ROC) curves for each predictor [expressed as area under the ROC curves (AUROC) with 95% confidence intervals (CI)].

Results: Data was available for 125 men and 86 women. The mean age was 63.3 ± 15.5 years, duration of CKD was 96.7 ± 125.3 months and one-third had diabetes. Patients with fractures were older and fell more frequently (P < 0.05). After adjusting for age, weight and sex, for every standard deviation increase in TUG and 6MW, the risk of fracture increased [odds ratio (OR): 1.68; 95% CI: 1.40-2.02] and decreased (OR: 0.53; 95% CI: 0.52-0.54), respectively. Both the TUG and 6MW could discriminate among those with and without fractures (AUROC: 0.90; 95% CI:0.84-0.95, AUROC: 0.87; 95% CI: 0.80-0.94, respectively).

Conclusions: The TUG and 6MW are able to discriminate fracture status in patients with Stages 3-5 CKD. These tests do not require specialized expertise/equipment and are an inexpensive method to assess for the presence of fractures.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bone Density
  • Creatinine / blood
  • Cross-Sectional Studies
  • Female
  • Follow-Up Studies
  • Fractures, Bone / etiology*
  • Fractures, Bone / physiopathology
  • Glomerular Filtration Rate
  • Hand Strength
  • Humans
  • Kidney Failure, Chronic / complications*
  • Logistic Models
  • Male
  • Middle Aged
  • Muscle, Skeletal / physiopathology*
  • Prognosis
  • ROC Curve
  • Spinal Fractures / etiology*
  • Spinal Fractures / physiopathology
  • Young Adult


  • Creatinine