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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., (Copyright (c) 2010. Published by Elsevier Inc.)

Objectives To determine whether anemia is a risk factor for functional decline in nursing home ( NH) residents with chronic kidney disease. Design Prospective 26-week observational study. Setting Eighty-two geographically representative NHs in the United States. Participants Three hundred eleven NH residents with chronic kidney disease ( CKD; estimated glomerular filtration rate <60 mL/min per 1.73 m2) who had anemia (hemoglobin <12 g/dL for women, <13 g/dL for men, n = 177) or not (n = 134). Measurements The primary outcome was the distance walked or wheeled for 10 minutes. Secondary outcomes were single chair stand time, grip strength, leg extension strength, Dartmouth Primary Care Cooperative Information scores, Modified Barthel Index, falls, hospitalization, and mortality. Results Mixed-effects model analysis of distance walked or wheeled showed that changes between weeks 2 and 14 but not between weeks 2 and 26 were significantly different between participants with CKD with anemia and those without anemia. There were no significant differences for the other physical performance or self-report measures. After adjustment for an anemia propensity score, participants with CKD with anemia did not have higher rates of hospitalization or death at 26 weeks than those without anemia. Conclusion Nursing home residents with CKD and anemia experienced greater decline than those with CKD without anemia only for a mobility distance task over a 3-month but not a 6-month period and not for other performance or self-report measures. Anemia may not increase the risk of functional decline in NH residents with CKD, but further research is necessary to confirm these findings and evaluate whether a lower hemoglobin cutpoint confers greater risk for functional decline in this population. [ABSTRACT FROM AUTHOR]