Diagnosis and Management of Anemia in Long-Term Care
Highlights of a Symposium
The supplement to Caring for the Ages was supported by an educational grant from Ortho Biotech and is jointly sponsored by the Elsevier Office of Continuing Medical Education and Caring for the Ages.
This supplement is based on proceedings of a symposium held on March 8, 2008, in Salt Lake City, Utah.
To view the supplement, click the image above. To take the CME test, download and print out the PDF file, and follow the test instructions on page 8.
Topics
• Introduction
• Identifying and Evaluating Anemia
• Appropriate Use of Erythropoiesis-Stimulating Agents for Residents with Chronic Kidney Disease
Faculty/Faculty Disclosure
Naushira Pandya, MD, CMD
Director, Geriatric Education Center
Associate Professor and Chair
Department of Geriatrics
Nova Southeastern University
College of Osteopathic Medicine
Fort Lauderdale, Fla. Dr. Pandya has disclosed that she has received grant/research support from Ortho Biotech. She plans to reference the off-label/unapproved uses of erythropoietin alpha and darbetoeitin.
Richard A. Lafayette, MD, FACP
Associate Professor of Medicine and Associate Chief
Director of Clinical Services
Division of Nephrology
Stanford University School of Medicine
Stanford, Calif. Dr. Lafayette has disclosed that he has been a consultant for Amgen Inc. and Ortho Biotech. He plans to reference off-label/unapproved uses of darbepoetin alfa and epoetin alfa.
Dr. Miller, Educational Reviewer, has nothing to disclose.
Target Audience
This activity is designed for long-term care medical directors, assisted living facility directors, directors of nursing, nursing supervisors, pharmacists in long-term care facilities, consultant pharmacists, psychiatrists, primary care physicians, and other health care professionals who are involved in the treatment of patients with chronic kidney disease-related anemia.
Needs Assessment
Anemia is common among long-term care residents, with a 6-month prevalence of 48% reported in one study. Anemia increases risk of disability and falling; the latter is a potentially serious consequence for older adults. Yet, roughly, one third of anemia cases in older adults are of unexplained etiology. Experts attribute this high rate in part to insufficient assessment. Anemia often is evaluated inadequately in long-term care facilities or incorrectly attributed to aging. This illustrates the necessity to educate providers about the need for, and the process of evaluating anemia in long-term care facility residents.
Chronic kidney disease (CKD) is a common cause of anemia in older adults. In the United States, roughly 19.5 million people have CKD, and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD) estimates that the prevalence of end-stage renal disease (ESRD) will reach over half a million by 2010. The kidney is the primary producer of erythropoietin in the adult human, so those with CKD are very susceptible to developing anemia because of erythropoietin deficiency. Early in 2007, the US Food and Drug Administration (FDA) issued a public health advisory about reports of serious and life-threatening side effects associated with erythropoiesis-stimulating agents (ESAs). This has stirred up a significant amount of discussion, so the need for proper education is paramount. Clinicians are being urged to use the lowest effective dose and to monitor individuals on treatment to ensure that hemoglobin levels remain within the new recommended range. Clinicians must be cognizant of assessing the need for maintenance therapy. As guidelines for ESAs continue to evolve and are updated, health care providers need to understand how these changes will impact their clinical practice.
Learning Objectives
•Determine the best approach for evaluating elderly residents with anemia.
•Explain the rationale for treating and list the clinical implications of untreated anemia in residents with CKD.
•Identify the causes of anemia in residents of long-term care facilities, including CKD.
•Define appropriate strategies for using erythropoiesis-stimulating agents safely and effectively in initial treatment and maintenance therapy, including appropriate dosing strategies.
•Develop a multidisciplinary approach to monitor and maintain the treatment of anemia in elderly residents with CKD.
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Elsevier Office of Continuing Medical Education (EOCME) and Caring for the Ages. The EOCME is accredited by the ACCME to provide continuing medical education (CME) for physicians.
The EOCME designates this educational activity for a maximum of 1 AMA PRA Category 1.0 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.
