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Paparazzo E, Geracitano S, Lagani V, Soraci L, Cozza A, Cosimo S, Morelli F, Corsonello A, Passarino G, Montesanto A. Clinical and Prognostic Implications of Estimating Glomerular Filtration Rate by Three Different Creatinine-Based Equations in Older Nursing Home Residents. Front Med (Lausanne) 2022; 9:870835. [PMID: 35559339 PMCID: PMC9087281 DOI: 10.3389/fmed.2022.870835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background According to the international literature, the percentage of nursing home (NH) residents with renal insufficiency is very high, ranging between 22 and 78%. Diminished kidney function represents a risk factor for drug overdosage, adverse drug reactions, end-stage renal disease, disability, morbidity, and mortality. Several studies suggested that screening for chronic kidney disease (CKD) in high-risk and older populations may represent a cost-effective approach to reducing progression to renal failure and CKD mortality. Objective This study aimed (i) to investigate to what extent CKD may be staged interchangeably by three different creatinine-based estimated glomerular filtration rate (eGFR) equations in a sample of older adults living in long-term care facilities; (ii) to investigate factors explaining differences among eGFR equations; and (iii) to compare the predictivity of different creatinine-based eGFR equations with respect to all-cause mortality. Methods A total of 522 residents aged 65 years and older participated in a prospective cohort study of 9 long-term care facilities in Calabria. eGFR was calculated by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Berlin initiative study (BIS), and full age spectrum (FAS) equations. Disability in at least one activity of daily living (ADL), depression, cognitive impairment, comorbidity, and malnutrition was considered in the analysis. Statistical analysis was carried out by Bland-Altman analysis, and 2-year mortality was investigated by Kaplan-Meier curves and Cox regression analysis. Results Depending on the adopted equation, the prevalence of NH residents with impaired renal function (eGFR < 60 ml/min/1.73 m2) ranged between 58.2% for the CKD-EPI and 79.1% for the BIS1 equation. The average difference between BIS and FAS was nearly negligible (0.45 ml/min/1.73 m2), while a significant bias was detected between CKD-EPI and BIS and also between CKD-EPI and FAS (6.21 ml/min/1.73 m2 and 6.65 ml/min/1.73 m2, respectively). Although the eGFR study equations had comparable prognostic accuracy in terms of mortality risk, BIS and FAS were able to reclassify NH residents pertaining to a low-risk group with CKD-EPI, and this reclassification improves the discriminative capacity of CKD-EPI with respect to overall mortality. Conclusion Despite the relatively good correlation between eGFRs calculated using all adopted equations, the findings in this study reported clearly demonstrated that CKD-EPI and BIS/FAS equations are not interchangeable to assess eGFR among older people and particularly in institutionalized and frail older subjects.
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Affiliation(s)
- Ersilia Paparazzo
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Silvana Geracitano
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Vincenzo Lagani
- Institute of Chemical Biology, Ilia State University, Tbilisi, Georgia.,Biological and Environmental Sciences and Engineering Division (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal, Saudi Arabia
| | - Luca Soraci
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Annalisa Cozza
- Laboratory of Pharmacoepidemiology and Biostatistics, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | | | | | - Andrea Corsonello
- Unit of Geriatric Medicine, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy.,Laboratory of Pharmacoepidemiology and Biostatistics, Italian National Research Center on Aging (IRCCS INRCA), Cosenza, Italy
| | - Giuseppe Passarino
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
| | - Alberto Montesanto
- Department of Biology, Ecology and Earth Sciences, University of Calabria, Rende, Italy
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Dörks M, Allers K, Schmiemann G, Herget-Rosenthal S, Hoffmann F. Inappropriate Medication in Non-Hospitalized Patients With Renal Insufficiency: A Systematic Review. J Am Geriatr Soc 2017; 65:853-862. [PMID: 28240771 DOI: 10.1111/jgs.14809] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Renal insufficiency is common among older patients and, accordingly, renally excreted drugs may require an adjustment in dosage for them. Rates of non-adherence to renal dosing guidelines range from 19% to 70% across all settings, with the highest rate occurring in outpatient care. However, there is a paucity of research in this field. The main objective of this systematic review is to assess how often drugs are inappropriately prescribed in non-hospitalized patients with renal insufficiency. DESIGN A systematic literature search was performed. Data were identified from three electronic databases: PubMed, CINAHL, and Scopus. Studies were included if they reported quantitative data on inappropriate drug use with respect to renal function in non-hospitalized patients. RESULTS Our search strategy resulted in 2,403 hits, of which 18 articles satisfied the criteria for inclusion. Mean estimated glomerular filtration rate ranged from 36.0 to 60.4 mL/min. Prevalence of renally inappropriate drug use ranged from 1% to 37% in outpatient settings other than nursing homes, and from 6% to 43% in nursing homes. Eight of the studies we included identified predictors for use of drugs inappropriate for kidney function. Most frequently determined risk factors were increasing age and a high number of prescribed drugs. CONCLUSION Lack of dose adjustment for renal impairment seems to be a common problem, even in outpatients. However, the differences in methodologies used in these studies hampered any direct comparison. Accepted and comparable standards regarding the drugs included in the studies as well as estimation of renal function would be beneficial.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Science, Department for Health Services Research, University of Bremen, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Hoffmann F, Boeschen D, Dörks M, Herget-Rosenthal S, Petersen J, Schmiemann G. Renal Insufficiency and Medication in Nursing Home Residents. A Cross-Sectional Study (IMREN). DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 113:92-8. [PMID: 26931625 DOI: 10.3238/arztebl.2016.0092] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 09/30/2015] [Accepted: 09/30/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Nursing home residents often suffer from a multiplicity of medical conditions and take many different drugs. Many drugs are eliminated via the kidneys and thus require dose adjustment in patients with renal insufficiency. This is the first study to address the prevalence of renal insufficiency among nursing home residents in Germany, and the extent to which such persons take drugs that are contraindicated or incorrectly dosed because of renal insufficiency. METHODS We carried out a cross-sectional study in nursing homes in the German regions of Bremen and Lower Saxony. Data were collected by nursing staff and given to us anonymously. Whenever the nursing home data did not include a current creatinine value, the patient's general practitioner was asked to supply this value. The estimated creatinine clearance (eCCr) was calculated with the Cockcroft-Gault formula. RESULTS 852 residents of 21 nursing homes were included in the study; eCCr values were obtainable for 685 (80.4%) of them (average age, 83.3 years; 75.2% female). 48.2% of these patients (95% confidence interval [CI] 41.8-54.5) had moderate renal insufficiency (eCCr 59-30 mL/min), and 15.5% (95% CI 12.4-18.6) had severe renal insufficiency (eCCr <30 mL/min). 19.7% were regularly taking at least one medication that was contraindicated or incorrectly dosed in the light of renal insufficiency. Predictors for such inappropriate drug use were advanced age, female sex, arterial hypertension, and polypharmacy. The drugs that were most often inappropriately used were metformin, ramipril, and potassium chloride. CONCLUSION Nursing home residents often suffer from renal insufficiency and should therefore have their creatinine levels measured regularly. A knowledge of the creatinine level is a prerequisite for the proper adjustment of drug doses (if necessary). A practical and compact summary of dose-adjustment recommendations for patients with renal insufficiency would be desirable but is not yet available.
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Affiliation(s)
- Falk Hoffmann
- Department of Health Services Research, Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Medical Clinic, Rotes-Kreuz-Krankenhaus, Bremen, Department of Health, Nursing and Age Studies, SOCIUM - Research Center on Inequality and Social Policy, University of Bremen, Department for Health Services Research, Institute for Public Health and Nursing Research, University of Bremen and Health Sciences Bremen
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Khan S, Hussain T, Salahuddin N, Mehreen S. Risk Factors of End Stage Renal Disease in Peshawar, Pakistan: Odds Ratio Analysis. Open Access Maced J Med Sci 2016; 4:381-387. [PMID: 27703559 PMCID: PMC5042619 DOI: 10.3889/oamjms.2016.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 05/31/2016] [Accepted: 06/01/2016] [Indexed: 11/05/2022] Open
Abstract
AIM: The basic aim of this study was to discover the association of End Stage Renal Disease (ESRD) with various risk factors. End Stage Renal Failure is the last stage of the chronic renal failure in which kidneys become completely fail to function. MATERIALS AND METHODS: The data were collected from the patients of renal diseases from three major hospitals in Peshawar, Pakistan. Odds ratio analysis was performed to examine the relationship of ESRD (a binary response variable) with various risk factors: Gender, Diabetic, Hypertension, Glomerulonephritis, Obstructive Nephropathy, Polycystic kidney disease, Myeloma, SLE Nephritis, Heredity, Hepatitis, Excess use of Drugs, heart problem and Anemia. RESULTS: Using odds ratio analysis, the authors found that the ESRD in diabetic patients was 11.04 times more than non-diabetic patients and the ESRD were 7.29 times less in non-hypertensive patients as compared to hypertensive patients. Similarly, glomerulonephritis patients had 3.115 times more risk of having ESRD than non-glomerulonephritis. Other risk factors may also, to some extent, were causes of ESRD but turned out insignificant due to stochastic sample. CONCLUSION: The authors concluded that there is a strong association between ESRD and three risk factors, namely diabetes, hypertension and glomerulonephritis.
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Affiliation(s)
- Salahuddin Khan
- Department of Family and Community Medicine, College of Medicine, University of Dammam, Kingdom of Saudi Arabia
| | | | - Najma Salahuddin
- Department of Statistics, Shaheed Benazir Bhutto Women University, Peshawar, Pakistan
| | - Salahuddin Mehreen
- Medical Officer, North West Hospital, Phase 5 Hayatabad, Peshawar, Pakistan
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Dörks M, Herget-Rosenthal S, Schmiemann G, Hoffmann F. Polypharmacy and Renal Failure in Nursing Home Residents: Results of the Inappropriate Medication in Patients with Renal Insufficiency in Nursing Homes (IMREN) Study. Drugs Aging 2016; 33:45-51. [PMID: 26659732 DOI: 10.1007/s40266-015-0333-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Polypharmacy has become an emerging public health issue in recent years, since use of multiple medications or polypharmacy is beneficial for many conditions, but may also have negative effects like adverse drug reactions. The risk further increases in patients with chronic renal failure, a comorbidity very frequent in nursing home residents. Since more than 50% of all drugs were renally excreted, dose adjustments in patients with renal failure are required. OBJECTIVE To assess polypharmacy in German nursing homes, in particular in residents with renal failure. METHODS Multi-center cross-sectional study in 21 nursing homes in Bremen and Lower Saxony/Germany. Baseline data were analysed using descriptive statistics. Multivariable logistic regression model and 95% confidence intervals were used to study the association of renal failure and polypharmacy. RESULTS Of all 852 residents, the analysis comprised those 685 with at least one serum creatinine value so that the estimated creatinine clearance could be calculated. Of those, 436 (63.6%) had a severe or moderate renal failure, defined as estimated creatinine clearance <60 mL/min. Polypharmacy (5-9 drugs) was found in 365 (53.3%) and excessive polypharmacy (≥10 drugs) in 112 (16.4%) residents. Diuretics and psycholeptics were the most commonly used drug classes. Severe renal failure (estimated creatinine clearance <30 mL/min) was associated with polypharmacy (OR: 2.8, 95% CI 1.4-5.7). CONCLUSION Both, polypharmacy and renal failure are common in German nursing home residents and an association of both could be found. Further studies are needed to assess the appropriateness of polypharmacy in these patients.
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Affiliation(s)
- Michael Dörks
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany.
| | | | - Guido Schmiemann
- Department of Health Services Research, Institute for Public Health and Nursing Science, University of Bremen, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Ammerländer Heerstrasse 140, 26111, Oldenburg, Germany
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Eren Z, Küçükardalı Y, Öztürk MA, Küçükardalı B, Kaspar EÇ, Kantarcı G. Prevalence, associated factors and impact on mortality of chronic kidney disease in nursing home residents: A single-center experience. Geriatr Gerontol Int 2014; 15:715-20. [DOI: 10.1111/ggi.12337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Zehra Eren
- Department of Nephrology; Yeditepe University Hospital; Istanbul Turkey
| | - Yaşar Küçükardalı
- Department of Internal Medicine; Yeditepe University Hospital; Istanbul Turkey
| | - Mehmet Akif Öztürk
- Department of Internal Medicine; Yeditepe University Hospital; Istanbul Turkey
| | - Betül Küçükardalı
- Department of Psychology; Yeditepe University Medical Faculty; Istanbul Turkey
| | - Elif Çiğdem Kaspar
- Department of Biostatistics; Yeditepe University Medical Faculty; Istanbul Turkey
| | - Gülçin Kantarcı
- Department of Nephrology; Yeditepe University Hospital; Istanbul Turkey
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Chan TC, Hung IFN, Chan KH, Li CPY, Li PTW, Luk JKH, Chu LW, Chan FHW. Immunogenicity and safety of intradermal trivalent influenza vaccination in nursing home older adults: a randomized controlled trial. J Am Med Dir Assoc 2014; 15:607.e5-12. [PMID: 24957950 DOI: 10.1016/j.jamda.2014.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/04/2014] [Accepted: 05/08/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the immunogenicity and safety between full-dose (15 μg) intramuscular (i.m.) and full-dose (15 μg) intradermal (i.d.) immunization of the trivalent influenza vaccine in nursing home older adults. DESIGN A single-center, randomized, controlled, open-label, parallel group trial from October 2013 to April 2014. SETTING Nine nursing homes in Hong Kong. PARTICIPANTS Hundred nursing home older adults (mean age: 82.9 ± 7.4 years). INTERVENTION Fifty received i.d. (Intanza) and 50 received i.m. (Vaxigrip) vaccination. MEASUREMENTS Baseline measurements included demographics, comorbidity, frailty and nutritional status. Day 21 and day 180 immunogenicity (seroconversion rate, seroprotection rate, geometric mean titer [GMT] fold increase in antibody titer) using hemagglutination-inhibition and adverse events were measured. Noninferiority and superiority of i.d. compared with i.m. vaccination in immunogenicity were analyzed. The study was registered on ClinicalTrials.gov; identifier: NCT 01967368. RESULTS At day 21, noninferiority in immunogenicity of the i.d. vaccination was demonstrated. The seroconversion rate of the H1N1 strain was significantly higher in the i.d. group. At day 180, immunogenicity of both groups fell but the GMT of all strains in i.d. group was higher and the difference was significant for H3N2 strain. The seroconversion rate and GMT fold increase of H3N2 strain was significantly higher in the i.d. group. Local adverse events was significantly more in i.d. group, but they were mild and resolved in 72 hours. CONCLUSIONS I.d. vaccination is noninferior, and even superior in some parts of immunogenicity assessment, to i.m. vaccination without compromising safety in nursing home older adults. I.d. vaccination is a good alternative to i.m. vaccination in this population.
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Affiliation(s)
- Tuen-Ching Chan
- Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, Hong Kong SAR, China; Division of Geriatrics, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
| | - Ivan Fan-Ngai Hung
- Division of Infectious Disease, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Kwok-Hung Chan
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Clara Pui-Yan Li
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Patrick Tsz-Wai Li
- Department of Microbiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - James Ka-Hay Luk
- Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, Hong Kong SAR, China
| | - Leung-Wing Chu
- Division of Geriatrics, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Felix Hon-Wai Chan
- Department of Medicine and Geriatrics, TWGHs Fung Yiu King Hospital, Hong Kong SAR, China
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Chan TC, Luk JKH, Chu LW, Chan FHW. Association between body mass index and cause-specific mortality as well as hospitalization in frail Chinese older adults. Geriatr Gerontol Int 2014; 15:72-9. [PMID: 24418288 DOI: 10.1111/ggi.12230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2013] [Indexed: 12/29/2022]
Abstract
AIM A U-shaped relationship between body mass index (BMI) and all-cause mortality has been reported, but there are few studies examining the association between BMI and cause-specific mortality and hospitalization. We carried out a longitudinal study to examine these associations in Chinese older adults with multiple comorbidities, which could provide a reference for the recommended BMI in this population. METHODS From 2004 to 2013, a retrospective cohort of Chinese older adults was selected from a geriatric day hospital in Hong Kong. They were divided into groups according to their BMI: BMI <16; BMI 16-18; BMI 18.1-20; BMI 20.1-22; BMI 22.1-24; BMI 24.1-26; BMI 26.1-28; BMI 28.1-30 and BMI >30. Other assessments included medical, functional, cognitive, social and nutritional assessment. RESULTS A total of 1747 older adults (mean age 80.8 ± 7.1 years, 44.1% male, 46.1% living in nursing homes, Charlson Comorbidity Index 2.0 ± 1.6) with a median follow up of 3.5 years were included. Older adults with BMI 24-28 had the lowest all-cause, infection-related and cardiovascular mortality (P < 0.001). Multivariate analysis showed that there was an inverted J-shaped association between BMI and hazard ratio for all-cause and infection-related mortality in both nursing home and community-dwelling older adults. The rate of all-cause hospitalization was lower in older adults with BMI 22-28 (P = 0.002). Multivariate analysis showed that there was an inverted J-shaped association between the odds ratio of recurrent hospitalization and BMI. CONCLUSION Chinese older adults with BMI 24-28 had lower all-cause mortality, infection-related mortality, cardiovascular-related mortality and all-cause hospitalization. This study provides a reference for the recommended BMI in this population.
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Affiliation(s)
- Tuen-Ching Chan
- Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong; Division of Geriatric Medicine, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
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Chan TC, Fan-Ngai Hung I, Ka-Hay Luk J, Chiu-Yat Woo P, Chu LW, Hon-Wai Chan F. Efficacy of Trivalent Seasonal Influenza Vaccination in Reducing Mortality and Hospitalization in Chinese Nursing Home Older Adults. J Am Med Dir Assoc 2013; 14:889-94. [DOI: 10.1016/j.jamda.2013.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 11/29/2022]
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Chan TC, Yap YHD, Hung FNI, Shea YF, Chu LW, Luk KHJ, Woo CYP, Chan HWF. The Efficacy of Influenza Vaccination is Reduced in Nursing Home Older Adults With Moderate to Severe Renal Impairment. J Am Med Dir Assoc 2013; 14:133-6. [DOI: 10.1016/j.jamda.2012.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 08/25/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
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Association between Functional Status of Chinese Nursing Home Older Adults and Long Term Mortality. J Am Med Dir Assoc 2013; 14:147.e1-5. [DOI: 10.1016/j.jamda.2012.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 10/24/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
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Chan TC, Yap DYH, Shea YF, Luk JKH, Chu LW, Chan FHW. Chronic Kidney Disease and Its Association With Mortality and Hospitalization in Chinese Nursing Home Older Residents: A 3-Year Prospective Cohort Study. J Am Med Dir Assoc 2012; 13:782-7. [DOI: 10.1016/j.jamda.2012.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 08/08/2012] [Accepted: 08/08/2012] [Indexed: 11/25/2022]
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Chan TC, Yap DYH, Shea YF, Luk JKH, Chan FHW, Chu LW. Prevalence of anemia in Chinese nursing home older adults: implication of age and renal impairment. Geriatr Gerontol Int 2012; 13:591-6. [PMID: 22994890 DOI: 10.1111/j.1447-0594.2012.00942.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM There is little data regarding the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. The objective of this study was to investigate the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. METHODS We carried out a retrospective cross-sectional study in nine nursing homes in Hong Kong. The hemoglobin (Hb) level, mean corpuscular volume (MCV), serum creatinine and comorbidities data of residents were examined. Older adults were regarded as anemic according to the World Health Organization criteria (Hb <13 g/dL for men and <12 g/dL for women). The glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD [Chinese-adjusted]) equation. Patients with chronic renal impairment were defined as having eGFR <60 mL/min/1.73 m(2) . RESULTS A total of 812 residents were included (mean age 86.0 ± 7.6 years). The mean hemoglobin was 12.0 ± 1.8 g/dL in men and 11.4 ± 1.6g/dL in women. The mean eGFR was 75.1 ± 31.7 mL/min/1.73 m(2) . A total of 67.0% of residents had anemia (70.5% in men and 65.2% in women). Anemic older adults were older and had a higher prevalence of renal impairment than non-anemic older adults (P<0.001). There was no significant difference between the two groups regarding the prevalence of other comorbidities. When stratified into different age groups, there were significant correlations between anemia and renal impairment in all subgroups (age ≤ 80 years, P<0.05; age 81-90 years, P<0.01; age >90 years, P<0.05). The same correlation was found between normocytic anemia and renal impairment. Conversely, when stratified according to eGFR (≥ 60 mL/min/1.73 m(2) vs <60 mL/min/1.73 m(2) ), we did not observe a significant correlation between anemia and age group. CONCLUSION In conclusion, anemia is prevalent in Chinese nursing home residents and is strongly associated with renal impairment. Further studies of early identification and management of anemia with renal impairment are recommended in this population.
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Affiliation(s)
- Tuen Ching Chan
- Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong, China.
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