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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]