Prevalence and severity of chronic kidney disease and anemia in the nursing home population.

OBJECTIVES: Chronic kidney disease (CKD) is an emerging health concern and may have important implications for the management of older people with many other chronic conditions, such as the nursing home (NH) resident population. This study was designed to describe the prevalence of CKD and associated comorbidities in a representative sample of NH residents. DESIGN: Cross-sectional descriptive study as a component of a prospective observational study of CKD and anemia in the NH population. SETTING: Eighty-two geographically representative NHs in the United States. PARTICIPANTS: Participants were 794 NH residents who had complete baseline data collected. MEASUREMENTS: Residents for whom consent was obtained underwent a record review focused on identifying a predefined set of comorbid conditions, clinical assessment, and blood and urine collections. Stage of CKD was based on estimated GFR (eGFR) using the MDRD equation: no CKD (eGFR > 60 mL/min/1.73 m(2)), Stage 3a (45-59), Stage 3b (30-44), and Stage 4/5 (< 30). RESULTS: Consent was obtained from 847 of 1626 residents screened; 32 were ineligible and 21 dropped out of the study; complete data were available for 794 residents. CKD was present in approximately 50% of residents; of these residents with CKD, 47.6% were stage 3a, 39.27% stage 3b, and 13.2% stage 4/5. Fifty percent of the population had anemia, and anemia was more common in those with CKD. The average number of comorbid conditions in the population was 5.3 (SD 2.2); the proportion of patients with multiple comorbid conditions, especially cardiovascular conditions, increased with increasing stage of CKD. Among those without CKD, 57% had 5 or more comorbidities in comparison to 87% of those with stage 4/5 CKD. CONCLUSIONS: In this representative sample of 794 US NH residents, 50% had clinical evidence of CKD. Patients with CKD, particularly those at later stages, were more likely to have cardiovascular comorbidities and anemia. The co-occurrence of these conditions in institutionalized populations may have important implications for the clinical management of this patient population, particularly as it relates to the potential for further renal complications.

Every-other-week darbepoetin alfa in the correction and maintenance of haemoglobin levels in elderly patients with chronic kidney disease: post hoc subanalysis of data from two clinical trials.

BACKGROUND: Anaemia is a common complication of chronic kidney disease (CKD) and is associated with increased rates of mortality and diminished quality of life in patients with CKD. Although extended dosing with darbepoetin alfa, an erythropoiesis-stimulating agent (ESA), has been shown to be effective in maintaining haemoglobin (Hb) levels in CKD patients, little information is published on the use of darbepoetin alfa in the correction and maintenance of Hb levels in elderly CKD patients naive to ESA therapy. OBJECTIVE: This post hoc subanalysis of data from two clinical trials was conducted to investigate the efficacy and safety profile of de novo every-other-week (q2w) darbepoetin alfa in elderly patients with CKD-associated anaemia (not on dialysis), as compared with that of a younger (aged <65 years) patient cohort. METHODS: This analysis was based on data obtained from two open-label, single-arm, multicentre studies of similar design. Patients were aged >or=18 years and naive to previous ESA therapy. Darbepoetin alfa administration was initiated at 0.75 microg/kg and titrated according to individual patient requirements to achieve and maintain Hb levels between 11.0 and 13.0 g/dL. The proportion of patients who achieved the primary endpoint, Hb >or=11.0 g/dL (study 1), and an Hb level between 11.0 and 13.0 g/dL (study 2) at weeks 4, 8 and 12 weeks and at the end of the study were determined. The results of this subanalysis were stratified by age (<65, 65-74 and >or=75 years). RESULTS: A total of 203 patients were enrolled in the two studies; 60% were female, 84 (41%) were aged <65 years, 57 (28%) were aged 65-74 years and 62 (31%) were aged >or=75 years. The proportion of patients who achieved Hb levels of >or=11.0 g/dL in study 1 and 11.0-13.0 g/dL in study 2 at week 20 were 93%, 96% and 92%, respectively, for the three age groups. Weight-adjusted q2w darbepoetin alfa doses were similar between the age groups and stable throughout the study period. The mean (standard deviation) Hb levels at week 21 were 12.0 (1.2), 12.7 (1.1) and 12.6 (1.0) g/dL in subjects aged <65, 65-74 and >or=75 years, respectively. The median (standard error) time to reach the primary endpoint was 5.0 (4.7), 5.0 (5.7) and 5.0 (5.7) weeks for subjects aged <65 years, 65-74 years and >or=75 years, respectively. The safety profiles of q2w darbepoetin alfa in both the older and younger age-groups were consistent with those expected for patients with CKD not receiving dialysis. CONCLUSIONS: The results of this study suggest that ESA-naive subjects aged <65, 65-74 and >or=75 years of age with CKD (not receiving dialysis) who received q2w darbepoetin alfa were able to achieve and maintain Hb levels at 11.0-13.0 g/dL. The de novo q2w treatment regimen with darbepoetin alfa described in the present report may help optimize anaemia management in CKD-associated anaemia patients, including those in the older adult population.

Chronic kidney disease, anemia, and the association between chronic kidney disease-related anemia and activities of daily living in older nursing home residents.

OBJECTIVES: The aim of this study was to evaluate the potential association between anemia associated with chronic kidney disease (CKD) and the ability for older nursing home (NH) residents with these conditions to perform basic activities of daily living (ADL). DESIGN: This is a multicenter, retrospective, observational study utilizing data abstracted from medical charts, laboratory records, and Minimum Data Set (MDS) records from the 1-year period before the date of data abstraction. SETTING: 24 NHs in the United States. PARTICIPANTS: Older (>or=65 years of age) NH residents with CKD (not receiving dialysis) who were not comatose and were alive as of the day of data abstraction were included in this analysis. MEASUREMENTS: Resident demographics, hemoglobin, and estimated glomerular filtration rate records, and ADL items were abstracted from the medical charts, laboratory records, and MDS. The prevalence of CKD and anemia associated with CKD was evaluated from laboratory records. The relationship between CKD, anemia, and ADLs was assessed through a repeated resampling (bootstrap) analysis. RESULTS: CKD was present in 45.7% of the residents. Of these, 60.5% had anemia. Residents with CKD and anemia were more likely to require limited or extensive assistance in performing ADLs such as bed mobility, transfer, walk in room, walk in corridor, locomotion on unit, dressing, and toilet use. Conversely, a greater proportion of residents with CKD but without anemia required no or slight supervision in performing these ADLs. CONCLUSION: CKD and anemia associated with CKD are common in older NH residents. The data suggest that older NH residents with CKD and anemia require greater assistance in performing ADLs than residents with CKD alone. These data support the importance of evaluating the older NH population for CKD and anemia. As with all retrospective analyses, study limitations must be considered in the interpretation of these results.

Prevalence of anemia in the nursing home: contribution of chronic kidney disease.

OBJECTIVES: To assess the independent contribution of chronic kidney disease (CKD) and age to anemia in older nursing home residents. DESIGN: Retrospective. SETTING: Skilled nursing facility. PARTICIPANTS: Nursing home residents with records in the Beverly Healthcare Data Warehouse who were admitted to a nursing home between January 1, 2002, and December 31, 2003; were alive as of January 31, 2004; and had hemoglobin and serum creatinine (SCr) values available for analysis. MEASUREMENTS: Prevalence of anemia (hemoglobin <13 g/dL for men and <12 g/dL for women) and CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m(2), according to Modification of Diet in Renal Disease criteria) and the contribution of CKD and age to the prevalence of anemia. RESULTS: Six thousand two hundred resident records were analyzed (70% female, 85% Caucasian). Overall, 59.6% of residents were anemic, and 43.1% had CKD, and residents with CKD were more likely to have anemia (64.9% with vs 55.7% without CKD; odds ratio (OR)=1.47, 95% confidence interval (CI)=1.33-1.63). Although older age was associated with lower hemoglobin values primarily in residents without CKD (Spearman rank correlation coefficient (r)=-0.10, P<.001), age had no association with hemoglobin in CKD (Spearman r=0.01, P=.60). The greater risk of anemia in the presence of CKD persisted in each age category (OR=2.07, 95% CI=1.53-2.80, aged 65-74; OR=1.44, 95% CI=1.21-1.70, aged 75-84; and OR=1.35, 95% CI=1.15-1.57, aged > or =85). CONCLUSION: Overall, these results suggest that CKD contributes more strongly than older age to the high prevalence of anemia in older nursing home residents.