Objective: To evaluate the prevalence of chronic kidney disease (CKD) and anemia in the long-term care facility, the rate of recognition of these conditions, and the specific interventions used to treat anemia.
Design: Retrospective cross-sectional analysis.
Setting: Twenty-seven long-term care facilities in Colorado.
Patients, participants: Had > 90-day residency in the long-term care facility; had index serum creatinine and hemoglobin (Hb) values ± 90 days of the earliest (index) Minimum Data Set (MDS). Data were derived from the AnalytiCare(sm) database (January 1, 2007-September 15, 2008) containing laboratory results, MDS reports, and pharmacy fills. Residents with laboratory-defined CKD had estimated glomerular filtration rates < 60 mL/min/1.73 m(2). Those with laboratory-defined anemia had < 12 g/dL Hb females, < 13 g/dL Hb males. MDS reports indicated recognition of CKD and anemia. Prescription records identified anemia-related pharmacotherapy for anemic residents.
Main outcome measurements: Prevalence rates of laboratory-defined CKD and anemia, recognition rates of anemia and CKD, and rates of use of specific anemia pharmacotherapies.
Results: For 838 eligible residents, laboratory findings showed a prevalence rate of 43% for CKD and 46% for anemia. Only 2.8% and 14.6% of residents with laboratory defined CKD had CKD recognized on the index, or any index or postindex MDS, respectively. Anemia recognition rates were 9.6% and 39.9%, respectively. No single anemia prescription therapy class (erythropoiesis stimulating agents, iron, vitamin B(12), or folic acid) was used for more than 10% of all residents with laboratory- or MDS-defined anemia.
Conclusion: For CKD and anemia, the lack of concordance between laboratory- and MDS-identified disease should alert health care professionals of potential under-recognition within the long-term care facility.