The Prevalence of Anemia in Older Nursing Facility (NF) Residents with Chronic Kidney Disease (CKD).

Anemia and CKD contribute to poor outcomes in the elderly. An understanding of chronic health conditions which may affect older NF residents, such as anemia and CKD, are important to providing optimal care to these residents. The objective of this study was to determine the proportion of NF residents who had CKD, anemia, and anemia associated with CKD, and to evaluate the use of anemia therapies in residents with CKD and Hb < 11 g/dL. ALTER (Anemia and associated outcomes in Long-TErm care Residents) was conducted in a representative sample of 24 NFs with Minimum Data Set (MDS) and prescription claims data available for the 1-year period before chart abstraction. Eligibility criteria included: ≥ 65 years of age, ≥ 1 hemoglobin (Hb) documentation, available records to estimate glomerular filtration rates (eGFR), not receiving dialysis, and not comatose. The first record to estimate GFR was used to analyze CKD status and the first subsequent Hb record was used to assess anemia status. CKD was conservatively defined as eGFR < 60mL/min/1.73m² (MDRD equation). Anemia was defined according to the WHO criteria of < 13 g/dL for men and < 12 g/dL for women. Treatment was evaluated for residents with CKD and a Hb < 11g/dL (NKF/KFDOQI Guidelines, 2003). A total of 1501 residents were eligible: 80.5% were white, 75.1% were female and the mean (SD) age was 84.1 (8.1) years. Anemia was identified in 54.7% (784/1434) of the residents and CKD was identified in 45.7% (686/1501) of the residents. Both CKD and anemia were diagnosed in 31.8% (210/661) of the residents. Only 15.6% (26/210) and 7.2% (12/210) of residents with CKD and Hb < 11 g/dL received iron therapy and erythropoiesis-stimulating protein treatment, respectively. The prevalence of select co-morbid conditions, which may also be associated with anemia, in residents with CKD and Hb < 11 g/dL were: diabetes, 43.1%; heart failure, 43.1%; and chronic infection, 25.7%. In summary, anemia associated with CKD is highly prevalent in older NF residents. Conventional treatment to correct anemia in residents with CKD was uncommon.