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


METHODS
Cross-sectional descriptive study as a component of a prospective observational study of CKD and anemia in the NH population.


METHODS
Eighty-two geographically representative NHs in the United States.


METHODS
Participants were 794 NH residents who had complete baseline data collected.


METHODS
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.
Department ofEpidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA 30322, USA. wmcclel@emory.edu
William M
WM
McClellan
Barbara
B
Resnick
Lei
L
Lei
Brian D
BD
Bradbury
Angela
A
Sciarra
Reshma
R
Kewalramani
Joseph G
JG
Ouslander
D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D009735:Nursing Homes; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology
D006454:Hemoglobins; D003404:Creatinine