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Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment

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Abstract

Objectives

To characterise the risk factors for chronic idiopathic normocytic anaemia (CINA) in older people, particularly the role of age-associated renal impairment.

Methods

Patients aged ≥65 years admitted to a medical unit over 12 months were assessed. Those with secondary causes of anaemia including chronic kidney disease (CKD) were excluded. CINA was defined as a haemoglobin <130 g/l for men and <120 g/l for women for at least 6 months without any apparent cause. Renal function was determined by estimating creatinine clearance (CrCl) using Cockcroft–Gault formula, and glomerular filtration rate (GFR) using modification of diet in renal disease (MDRD) and chronic kidney disease epidemiology collaboration (CKD-EPI) formulas.

Results

116 had CINA. Controls were 572. The mean estimates of renal function were significantly lower in cases as compared with controls (P < 0.001). The risk of CINA increased by 12.6, 10.4 and 12 %, respectively, for each unit decrease in CrCl, MDRD-eGFR and CKD-EPI-eGFR, independent of age and other covariates. The adjusted odds ratios for CINA in those with CrCl, MDRD or CKD-EPI eGFR <60 ml/min/1.73 m2 were 2.68 (CI 1.53–4.70); 2.70 (CI 1.57–4.62) and 2.12 (CI 1.46–3.74), respectively. Other covariates in the model that were independently associated with CINA included advanced age, diabetes mellitus (DM), use of angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB), history of dementia and living in a residential care facility.

Conclusions

Age-associated renal impairment independently contributes to CINA. Other potential risk factors for CINA include advanced age, DM and ACEI or ARB use.

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Acknowledgments

The authors thank the clinical coordinators and nursing staff of the General Internal Medicine Unit, Western Health, for their help with this study.

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Author notes

  1. Mahesan Anpalahan

    Present address: Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia

Authors and Affiliations

  1. Department of General Medicine, Western Health, Melbourne, Australia

    Mahesan Anpalahan & Kar Yan Lo

  2. Department of Medicine, North West Academic Centre, The University of Melbourne, Melbourne, Australia

    Mahesan Anpalahan

  3. Department of General Internal Medicine, Eastern Health, Albert Street, Melbourne, VIC, 3156, Australia

    Hui Yi Ng

  4. National Ageing Research Institute (NARI), Melbourne, Australia

    Steven Savvas & Stephen Gibson

Authors
  1. Mahesan Anpalahan
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  2. Steven Savvas
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Correspondence to Mahesan Anpalahan.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Anpalahan, M., Savvas, S., Lo, K.Y. et al. Chronic idiopathic normocytic anaemia in older people: the risk factors and the role of age-associated renal impairment. Aging Clin Exp Res 29, 147–155 (2017). https://doi.org/10.1007/s40520-016-0563-0

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  • DOI: https://doi.org/10.1007/s40520-016-0563-0

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