Association of Mild Anemia with Cognitive, Functional, Mood and Quality of Life Outcomes in the Elderly: The “Health and Anemia” Study

BACKGROUND: In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons. METHODS: Among the 4,068 eligible individuals aged 65-84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia. RESULTS: In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable. CONCLUSIONS: Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings

Mortality Prediction in the Oldest Old with Five Different Equations to Estimate Glomerular Filtration Rate: The Health and Anemia Population-based Study.

Kidney function declines considerably with age, but little is known about its clinical significance in the oldest-old.To study the association between reduced glomerular filtration rate (GFR) estimated according to five equations with mortality in the oldest-old.Prospective population-based study.Municipality of Biella, Piedmont, Italy.700 subjects aged 85 and older participating in the "Health and Anemia" Study in 2007-2008.GFR was estimated using five creatinine-based equations: the Cockcroft-Gault (C-G), Modification of Diet in Renal Disease (MDRD), MAYO Clinic, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Berlin Initiative Study-1 (BIS-1). Survival analysis was used to study mortality in subjects with reduced eGFR (<60 mL/min/1.73 m(2)) compared to subjects with eGFR ≥ 60 mL/min/1.73 m(2).Prevalence of reduced GFR was 90.7% with the C-G, 48.1% with MDRD, 23.3% with MAYO, 53.6% with CKD-EPI and 84.4% with BIS-1. After adjustment for confounders, two-year mortality was significantly increased in subjects with reduced eGFR using BIS-1 and C-G equations (adjusted HRs: 2.88 and 3.30, respectively). Five-year mortality was significantly increased in subjects with eGFR <60 mL/min/1.73 m(2) using MAYO, CKD-EPI and, in a graduated fashion in reduced eGFR categories, MDRD. After 5 years, oldest old with an eGFR <30 mL/min/1.73 m(2) showed a significantly higher risk of death whichever equation was used (adjusted HRs between 2.04 and 2.70).In the oldest old, prevalence of reduced eGFR varies noticeably depending on the equation used. In this population, risk of mortality was significantly higher for reduced GFR estimated with the BIS-1 and C-G equations over the short term. Though after five years the MDRD appeared on the whole a more consistent predictor, differences in mortality prediction among equations over the long term were less apparent. Noteworthy, subjects with a severely reduced GFR were consistently at higher risk of death regardless of the equation used to estimate GFR

Mean (SD) estimated glomerular filtration rate (eGFR) of oldest old with and without vascular diseases/risk factors ¹.

<p>C-G: Cockcroft and Gault equation; MDRD: Modification of Diet in Renal Disease formula; MAYO: MAYO Clinic quadratic equation; CKD-EPI: Chronic Kidney Disease Epidemiology Collaboration formula; BIS-1: Berlin Initiative Study 1; CI: Confidence Intervals</p><p>^<b>1</b> Vascular diseases/risk factors: diabetes, hypertension, heart failure, myocardial infarction, and stroke.</p><p>² n = 144 (without vascular diseases/risk factors) and n = 515 (with vascular diseases/risk factors).</p><p>Mean (SD) estimated glomerular filtration rate (eGFR) of oldest old with and without vascular diseases/risk factors <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0136039#t003fn002" target="_blank">¹</a>.</p

Distribution of estimated Glomerular Filtration Rate (eGFR) according to Cockcroft and Gault equation (C-G); Modification of Diet in Renal Disease (MDRD) formula; MAYO Clinic quadratic equation (MAYO); Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula; Berlin Initiative Study 1 (BIS-1).

<p>Distribution of estimated Glomerular Filtration Rate (eGFR) according to Cockcroft and Gault equation (C-G); Modification of Diet in Renal Disease (MDRD) formula; MAYO Clinic quadratic equation (MAYO); Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula; Berlin Initiative Study 1 (BIS-1).</p

Age groups and sex adjusted survival by estimated Glomerular Filtration Rate (eGFR) according to a) Cockcroft and Gault equation (C-G); b) Modification of Diet in Renal Disease (MDRD) formula; (c) MAYO Clinic quadratic equation (MAYO); d) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula; e) Berlin Initiative Study 1 (BIS-1).

<p>Age groups and sex adjusted survival by estimated Glomerular Filtration Rate (eGFR) according to a) Cockcroft and Gault equation (C-G); b) Modification of Diet in Renal Disease (MDRD) formula; (c) MAYO Clinic quadratic equation (MAYO); d) Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula; e) Berlin Initiative Study 1 (BIS-1).</p

Baseline Characteristics of the Study Population (N between 622 and 700).

<p>^a BMI, Body Mass Index</p><p>^b Respiratory failure = use of O₂ or bronchodilators</p><p>^cAnemia was defined by the WHO criteria as hemoglobin concentration <12.0 g/mL in women and <13.0 g/mL in men</p><p>^dBUN, Blood Urea Nitrogen.</p><p>Baseline Characteristics of the Study Population (N between 622 and 700).</p

Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study

Mild anemia is a frequent laboratory finding in the elderly usually disregarded in clinical practice. This study shows that mild anemia is associated with increased risk of hospitalization and all-cause mortality in the elderly. See perspective article on page 1