title: Disentangling the Impact of Chronic Kidney Disease, Anemia, and Mobility Limitation on Mortality in Older Patients Discharged From Hospital.
abstract: BACKGROUND
  Chronic kidney disease (CKD), anemia, and mobility limitation are important predictors of mortality. We aimed at investigating the interactions between estimated glomerular filtration rate (eGFR), anemia, and physical performance on 1-year mortality in older patients discharged from acute care hospitals.
  
  
  METHODS
  Four hundred and eighty seven patients enrolled in a multicenter, prospective observational study were included in the analysis. eGFR was estimated by the Berlin Initiative Study 1 equation. Anemia was defined on the basis of hemoglobin values. Mobility limitation was rated by the Short Physical Performance Battery (SPPB). Covariates included demographics, nutritional status, cognitive performance, and comorbidity. The outcome of the study was mortality over 1-year follow-up. Interactions among study variables were investigated by survival tree analysis.
  
  
  RESULTS
  eGFR < 30 mL/min/1.73 m(2), anemia, and SPPB = 0-4 were significantly associated with mortality, as were hypoalbuminemia and cognitive impairment. Survival tree analysis showed that compared to patients with SPPB ≥ 4 and eGFR ≥ 46.7 mL/min/1.73 m(2) (ie, patients with the least mortality), patients with SPPB < 4 and hemoglobin < 12.2 g/dL had the highest risk of mortality [hazard ratio (HR) = 28.9, 95%CI 10.3-81.2]. Patients with SPPB ≥ 4 and eGFR < 46.7 mL/min/1.73 m(2) and those with SPPB > 4, hemoglobin ≥ 12.2g/dL, and eGFR ≥ 58.6 mL/min/1.73 m(2) had intermediate risk (HR = 6.58, 95%CI = 2.15-20.2, and HR = 15.11, 95%CI=4.42-51.7, respectively). Having SPPB < 4, hemoglobin ≥ 12.2 g/dL, and eGFR<58.6 mL/min/l.73 m(2) was not significantly associated with increased mortality (HR = 2.95, 95%CI = 0.74-11.8).
  
  
  CONCLUSIONS
  Interactions among eGFR, anemia, and mobility limitation define different profiles of risk in older patients discharged from acute care hospitals, which deserve to be considered to identify patients needing special care and careful follow-up after discharge.
authors.affiliation: Italian National Research Center on Aging (INRCA), Scientific Direction, Ancona, Italy.
authors.forename: Fabrizia
authors.initials: F
authors.lastname: Lattanzio
authors.affiliation: Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Center on Aging (INRCA), Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Corsonello
authors.affiliation: Department of Cell Biology, University of Calabria, Arcavacata di Rende, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Montesanto
authors.affiliation: Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Center on Aging (INRCA), Italy.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Abbatecola
authors.affiliation: DIMEG, University of Calabria, Arcavacata di Rende, Italy.
authors.forename: Danilo
authors.initials: D
authors.lastname: Lofaro
authors.affiliation: Department of Cell Biology, University of Calabria, Arcavacata di Rende, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Passarino
authors.affiliation: Unit of Geriatric Pharmacoepidemiology, Research Hospital of Cosenza, Italian National Research Center on Aging (INRCA), Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Fusco
authors.affiliation: Unit of Geriatric Medicine, Department of Internal Medicine, University of Messina, Messina, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Corica
authors.affiliation: Chair of Geriatric Medicine, University Campus BioMedico, Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pedone
authors.affiliation: Department of Clinical and Experimental Medicine, Geriatric Clinic, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Maggio
authors.affiliation: Department of Clinical and Experimental Medicine, Section of Internal Medicine, Gerontology and Geriatrics, University of Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: Chair of Geriatric Medicine, University Campus BioMedico, Rome, Italy.
authors.forename: Raffaele Antonelli
authors.initials: RA
authors.lastname: Incalzi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000401:mortality*; D003072:Cognition Disorders / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D034141:Hypoalbuminemia / Q000401:mortality; D007558:Italy / Q000453:epidemiology; D008297:Male; D051346:Mobility Limitation; D010351:Patient Discharge; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000401:mortality*
chemical_list: D006454:Hemoglobins
keywords: 1-year mortality; Anemia; Estimated glomerular filtration rate; Mobility limitation; Net reclassification improvement.; Short physical performance battery; Survival tree analysis