Clinical InvestigationImpact of congestive heart failure, chronic kidney disease, and anemia on survival in the Medicare population☆
Section snippets
Methods
This study was a retrospective cohort study using the 5% general Medicare database. The Medicare database is maintained by the Centers for Medicare & Medicaid Services. The 5% general Medicare database is a random sample generated by selecting all Medicare beneficiaries who have 05, 20, 45, 70, or 95 in the last 2 positions of their health insurance claim number.
The study cohort was derived from the Medicare 5% Denominator Files for 1996–1999 and included patients who were continuously enrolled
Baseline characteristics
A total of 1,321,156 patients were continuously enrolled in both Medicare Part A and Part B and were not enrolled in a health maintenance organization during 1996 and 1997. Excluded from this total were 6733 (0.5%) patients who died; 10,584 (0.8%) patients who had ESRD before the follow-up started; 2293 (0.2%) patients who did not reside in the 50 states, the District of Columbia, Puerto Rico, or the territories; and 172,149 (13%) patients who were younger than 67 years old on December 31,
Discussion
This large cohort study found that CKD and anemia are independently associated with increased mortality in elderly patients. This was particularly prominent in those with CHF. The relative risk of death persisted for both anemia and CKD, even after adjusting for other comorbid conditions. Approximately 35 million US citizens are older than 65 years of age.14 On the basis of the prevalences we noted, we estimate that approximately 4.5 million of these people have CHF and approximately 5 million
Acknowledgements
The authors thank Delaney Berrini and James Kaufmann of Nephrology Analytical Services for figure creation and manuscript editing, respectively.
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Supported by an unrestricted research grant from Amgen Inc., Thousand Oaks, California.