Chronic Kidney Disease, Anemia, and the Association Between Chronic Kidney Disease-Related Anemia and Activities of Daily Living in Older Nursing Home Residents

Abstract

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). 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. 24 NHs in the United States. 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. 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. 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. 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.