G. Röhrig

Anämie und Eisenmangel in der Geriatrie

The prevalence of anemia in geriatric patients is high. With some variation in different patient cohorts, prevalence of anemia can reach 40%. Anemia is not an age-related disease on its own, but is a symptom with multifactorial genesis and high risk potential. It directly influences mortality, morbidity, and the rate of hospitalization, particularly in older patients suffering from chronic heart failure or chronic kidney disease. The high prevalence of anemia in chronic kidney disease is explained by a combination of erythropoietin and iron deficiency. This review summarizes the recommendations of the iron symposium at the 2010 German Geriatric Society Meeting in Potsdam, Germany. It intends to provide current information on prevalence, diagnostic work-up, and therapeutic options for anemia in the rapidly growing group of elderly patients.ZusammenfassungDie Anämie hat bei geriatrischen Patienten eine hohe Prävalenz. Diese beträgt bis zu 40% je nach untersuchtem Kollektiv. Anämie ist jedoch keine altersassoziierte eigenständige Erkrankung, sondern ein Symptom mit multifaktorieller Genese und hohem Risikopotenzial. Aufgrund ihrer direkten Einflussnahme auf Mortalität, Morbidität und Hospitalisierung ist eine differenzierte Diagnostik zur gezielten Therapieeinleitung von hoher klinischer und ökonomischer Bedeutung. Besonders im Zusammenhang mit chronischer Herzinsuffizienz gilt die Anämie inzwischen als unabhängiger Risikofaktor für Mortalität. Die hohe Prävalenz der Anämie bei chronischer Nierenerkrankung lässt sich heute durch einen kombinierten Mangel an Erythropoetin und Eisen erklären. Der vorliegende Beitrag beruht auf einer Zusammenfassung eines Satellitensymposiums während der Jahrestagung der Deutschen Gesellschaft für Geriatrie 2010 in Potsdam. Er enthält eine Übersicht über Prävalenz und Auswirkung der Anämie im Alter und beleuchtet diagnostische Maßnahmen sowie aktuelle therapeutische Optionen.AbstractThe prevalence of anemia in geriatric patients is high. With some variation in different patient cohorts, prevalence of anemia can reach 40%. Anemia is not an age-related disease on its own, but is a symptom with multifactorial genesis and high risk potential. It directly influences mortality, morbidity, and the rate of hospitalization, particularly in older patients suffering from chronic heart failure or chronic kidney disease. The high prevalence of anemia in chronic kidney disease is explained by a combination of erythropoietin and iron deficiency. This review summarizes the recommendations of the iron symposium at the 2010 German Geriatric Society Meeting in Potsdam, Germany. It intends to provide current information on prevalence, diagnostic work-up, and therapeutic options for anemia in the rapidly growing group of elderly patients.

[Anemia and iron deficiency in the elderly. Prevalence, diagnostics and new therapeutic options].

The prevalence of anemia in geriatric patients is high. With some variation in different patient cohorts, prevalence of anemia can reach 40%. Anemia is not an age-related disease on its own, but is a symptom with multifactorial genesis and high risk potential. It directly influences mortality, morbidity, and the rate of hospitalization, particularly in older patients suffering from chronic heart failure or chronic kidney disease. The high prevalence of anemia in chronic kidney disease is explained by a combination of erythropoietin and iron deficiency. This review summarizes the recommendations of the iron symposium at the 2010 German Geriatric Society Meeting in Potsdam, Germany. It intends to provide current information on prevalence, diagnostic work-up, and therapeutic options for anemia in the rapidly growing group of elderly patients.ZusammenfassungDie Anämie hat bei geriatrischen Patienten eine hohe Prävalenz. Diese beträgt bis zu 40% je nach untersuchtem Kollektiv. Anämie ist jedoch keine altersassoziierte eigenständige Erkrankung, sondern ein Symptom mit multifaktorieller Genese und hohem Risikopotenzial. Aufgrund ihrer direkten Einflussnahme auf Mortalität, Morbidität und Hospitalisierung ist eine differenzierte Diagnostik zur gezielten Therapieeinleitung von hoher klinischer und ökonomischer Bedeutung. Besonders im Zusammenhang mit chronischer Herzinsuffizienz gilt die Anämie inzwischen als unabhängiger Risikofaktor für Mortalität. Die hohe Prävalenz der Anämie bei chronischer Nierenerkrankung lässt sich heute durch einen kombinierten Mangel an Erythropoetin und Eisen erklären. Der vorliegende Beitrag beruht auf einer Zusammenfassung eines Satellitensymposiums während der Jahrestagung der Deutschen Gesellschaft für Geriatrie 2010 in Potsdam. Er enthält eine Übersicht über Prävalenz und Auswirkung der Anämie im Alter und beleuchtet diagnostische Maßnahmen sowie aktuelle therapeutische Optionen.AbstractThe prevalence of anemia in geriatric patients is high. With some variation in different patient cohorts, prevalence of anemia can reach 40%. Anemia is not an age-related disease on its own, but is a symptom with multifactorial genesis and high risk potential. It directly influences mortality, morbidity, and the rate of hospitalization, particularly in older patients suffering from chronic heart failure or chronic kidney disease. The high prevalence of anemia in chronic kidney disease is explained by a combination of erythropoietin and iron deficiency. This review summarizes the recommendations of the iron symposium at the 2010 German Geriatric Society Meeting in Potsdam, Germany. It intends to provide current information on prevalence, diagnostic work-up, and therapeutic options for anemia in the rapidly growing group of elderly patients.

Association of anemia and hypoalbuminemia in German geriatric inpatients: Relationship to nutritional status and comprehensive geriatric assessment.

BackgroundAnemia and hypoalbuminemia (HA) are acknowledged independent risk factors for morbidity and mortality in geriatric patients and are associated with nutritional status and frailty. Data exist regarding the association between albumin and frailty, anemia and frailty as well as frailty and nutritional status; however, there is a lack of information on the association between HA, anemia and nutritional status in older people.Patients and methodsThis study retrospectively analyzed 626 patients admitted to a German geriatrics department (average age 81.1 years, 68.2 % female and 31.8 % male) for anemia and HA. Data from the comprehensive geriatric assessment (CGA) and from the mini-nutritional assessment (MNA) were available in all patients.ResultsPatients with anemia suffered significantly more often from HA (p < 0.001) than patients without anemia, with an odds ratio (OR) of 1.99 (95 % confidence interval CI: 1.2-3.2) and of 5.41 (CI 95 %: 2.3-12.6) in patients at risk for malnutrition and in malnourished patients, respectively. A moderately significant association was seen between hemoglobin (Hb) and albumin values (Pearson’s correlation r = 0.330; p < 0.001) as well as between albumin values and the Barthel index (Spearman’s correlation r = 0.210; p < 0.001).ConclusionAnemia appears to be a risk factor for HA in inpatients with malnutrition and the observed association between albumin and Hb warrants further research. Geriatric inpatients with anemia should be evaluated in terms of the presence of malnutrition risk and HA.ZusammenfassungHintergrundAnämie und Hypoalbuminämie (HA) sind bei geriatrischen Patienten bekannte unabhängige Risikofaktoren für Morbidität und Mortalität, sie stehen im Zusammenhang mit Ernährungststatus und Frailty. Es gibt Untersuchungen zum Zusammenhang zwischen Albumin und Frailty, Anämie und Frailty, sowie Frailty und dem Ernährungsstatus. Bisher fehlen jedoch Daten zu einem Zusammenhang zwischen HA, Anämie und Ernährungsstatus bei geriatrischen Patienten.Patienten und MethodenRetrospektive Datenanalyse von 626 stationären geriatrischen Patienten (mittleres Alter 81,1 Jahre, 68,2 % Frauen, 31,8 % Männer) hinsichtlich Anämie, HA und einem Zusammenhang mit dem Ernährungsstatus (Mini Nutritional Assessment, MNA) und dem multidimensionalen geriatrischen Assessment (Comprehensive Geriatric Assessment, CGA).ErgebnissePatienten mit Anämie wiesen signifikant häufiger eine HA auf (p < 0,001) als Patienten ohne Anämie, wobei anämische Patienten mit einem Risiko für Mangelernährung eine erhöhte Chance auf eine HA hatten (OR I,9; 95 %-KI: 1,2-3,2) und Patienten mit einer Mangelernährung eine OR von 5,4 (95 %-KI: 2,3-12,6) aufwiesen. Ein moderater signifikanter Zusammenhang konnte gezeigt werden zwischen Hämoglobin (Hb) und Albumin (Pearsons Korrelationskoeffizient r = 0,330; p < 0,001) sowie zwischen Albumin und Barthel Index.SchlussfolgerungenAnämie scheint bei mangelernährten stationär geriatrischen Patienten ein Risikofaktor für HA zu sein, wobei der beobachtete Zusammenhang zwischen Albumin und Hb weiterer wissenschaftlicher Untersuchungen bedarf. Im klinischen Alltag sollte bei stationär geriatrischen Patienten mit Anämie eine Überprüfung auf HA erwogen werden, besonders bei drohender oder bereits bestehender Mangelernährung.

Association of anemia and hypoalbuminemia in German geriatric inpatients

BackgroundAnemia and hypoalbuminemia (HA) are acknowledged independent risk factors for morbidity and mortality in geriatric patients and are associated with nutritional status and frailty. Data exist regarding the association between albumin and frailty, anemia and frailty as well as frailty and nutritional status; however, there is a lack of information on the association between HA, anemia and nutritional status in older people.Patients and methodsThis study retrospectively analyzed 626 patients admitted to a German geriatrics department (average age 81.1 years, 68.2 % female and 31.8 % male) for anemia and HA. Data from the comprehensive geriatric assessment (CGA) and from the mini-nutritional assessment (MNA) were available in all patients.ResultsPatients with anemia suffered significantly more often from HA (p < 0.001) than patients without anemia, with an odds ratio (OR) of 1.99 (95 % confidence interval CI: 1.2-3.2) and of 5.41 (CI 95 %: 2.3-12.6) in patients at risk for malnutrition and in malnourished patients, respectively. A moderately significant association was seen between hemoglobin (Hb) and albumin values (Pearson’s correlation r = 0.330; p < 0.001) as well as between albumin values and the Barthel index (Spearman’s correlation r = 0.210; p < 0.001).ConclusionAnemia appears to be a risk factor for HA in inpatients with malnutrition and the observed association between albumin and Hb warrants further research. Geriatric inpatients with anemia should be evaluated in terms of the presence of malnutrition risk and HA.ZusammenfassungHintergrundAnämie und Hypoalbuminämie (HA) sind bei geriatrischen Patienten bekannte unabhängige Risikofaktoren für Morbidität und Mortalität, sie stehen im Zusammenhang mit Ernährungststatus und Frailty. Es gibt Untersuchungen zum Zusammenhang zwischen Albumin und Frailty, Anämie und Frailty, sowie Frailty und dem Ernährungsstatus. Bisher fehlen jedoch Daten zu einem Zusammenhang zwischen HA, Anämie und Ernährungsstatus bei geriatrischen Patienten.Patienten und MethodenRetrospektive Datenanalyse von 626 stationären geriatrischen Patienten (mittleres Alter 81,1 Jahre, 68,2 % Frauen, 31,8 % Männer) hinsichtlich Anämie, HA und einem Zusammenhang mit dem Ernährungsstatus (Mini Nutritional Assessment, MNA) und dem multidimensionalen geriatrischen Assessment (Comprehensive Geriatric Assessment, CGA).ErgebnissePatienten mit Anämie wiesen signifikant häufiger eine HA auf (p < 0,001) als Patienten ohne Anämie, wobei anämische Patienten mit einem Risiko für Mangelernährung eine erhöhte Chance auf eine HA hatten (OR I,9; 95 %-KI: 1,2-3,2) und Patienten mit einer Mangelernährung eine OR von 5,4 (95 %-KI: 2,3-12,6) aufwiesen. Ein moderater signifikanter Zusammenhang konnte gezeigt werden zwischen Hämoglobin (Hb) und Albumin (Pearsons Korrelationskoeffizient r = 0,330; p < 0,001) sowie zwischen Albumin und Barthel Index.SchlussfolgerungenAnämie scheint bei mangelernährten stationär geriatrischen Patienten ein Risikofaktor für HA zu sein, wobei der beobachtete Zusammenhang zwischen Albumin und Hb weiterer wissenschaftlicher Untersuchungen bedarf. Im klinischen Alltag sollte bei stationär geriatrischen Patienten mit Anämie eine Überprüfung auf HA erwogen werden, besonders bei drohender oder bereits bestehender Mangelernährung.

Anämie im Alter

Anemia is not physiologically associated with increasing age but a symptom of an underlying disease. The individual patients wish, results of geriatric assessment, and therapeutic options regarding life expectancy and quality of life must be taken into consideration when determining the diagnostic steps to be taken. Prevalence of anemia is high, reaching up to 40% among geriatric inpatients. There are various reasons for anemia, but the three most frequent forms of anemia in the elderly are iron deficient anemia (IDA), anemia of chronic diseases (ACD), and unexplained anemia (UA). This article will, therefore, be limited to these forms. Until now no guidelines have been developed concerning diagnostic and therapeutic steps for anemia in the elderly. For basic diagnostics, the analysis of hematologic parameters such as hemoglobin, ferritin, and the saturation of transferrin are recommended. Therapeutic options have to be chosen according to the underlying disease.ZusammenfassungAnämie ist keine physiologische Erscheinung des höheren Lebensalters, sondern Symptom einer zugrunde liegenden Erkrankung. Die Frage nach Abklärung dieser Erkrankung muss individuell entschieden werden, abhängig von Patientenwunsch, geriatrischem Assessment und Therapieoptionen. Dabei sind Lebensqualität und Lebenserwartung zu berücksichtigen. Die Prävalenz der Anämie im Alter ist hoch und betrifft unter stationär behandelten geriatrischen Patienten fast jeden zweiten. Die Ursachen sind vielfältig, wobei die häufigsten Formen im höheren Lebensalter die Eisenmangelanämie (IDA), die Anämie chronischer Erkrankungen (ACD) und die unklare Anämie (UA) sind. Daher beschränkt sich dieser Beitrag auf Diagnostik und Therapie dieser Formen. Es gibt bis heute keine Leitlinie für die Diagnostik und Therapie der Anämie im Alter. Als diagnostische Basis bietet sich die Erfassung von Blutbild, Ferritin und Transferrinsättigung an. Die therapeutischen Maßnahmen richten sich nach der Grunderkrankung.AbstractAnemia is not physiologically associated with increasing age but a symptom of an underlying disease. The individual patient’s wish, results of geriatric assessment, and therapeutic options regarding life expectancy and quality of life must be taken into consideration when determining the diagnostic steps to be taken. Prevalence of anemia is high, reaching up to 40% among geriatric inpatients. There are various reasons for anemia, but the three most frequent forms of anemia in the elderly are iron deficient anemia (IDA), anemia of chronic diseases (ACD), and unexplained anemia (UA). This article will, therefore, be limited to these forms. Until now no guidelines have been developed concerning diagnostic and therapeutic steps for anemia in the elderly. For basic diagnostics, the analysis of hematologic parameters such as hemoglobin, ferritin, and the saturation of transferrin are recommended. Therapeutic options have to be chosen according to the underlying disease.

Red blood cell counts and indices in the elderly German population

Abstract Background Data on peripheral blood cell values in older subjects are rare. While hemoglobin (Hb) values are supposed to change with rising age, little is known about reference values for other erythrocytic blood cell counts. This cross-sectional study was initiated to analyze hematologic laboratory parameters among subjects aged ≥60 years. Methods This was a retrospective cross-sectional study of outpatient laboratory data between January 1st and December 31st, 2015 originating from a German countrywide laboratory group; inclusion criteria: age ≥60 years, normal C-reactive protein (CRP), transferrin saturation, reticulocytes, lactate dehydrogenase, haptoglobin and soluble transferrin receptor; exclusion criteria: glomerular filtration rate (GFR)<60 mL/min, lack of inclusion criteria; primary objective: assessment of the mean Hb value; secondary objective: assessment of mean values of red blood cell (RBC) counts. Results Of 30,611 subjects ≥60 years, 4641 met the inclusion criteria and were thus considered hematologically healthy; the following age groups were formed: 60–69 years (2094), 70–79 years (2171), 80–89 years (360), >90 years (16); median values for male/female subjects were: Hb 15.2/14.0 g/dL, RBC 5.0/4.6/μL, mean cellular volume (MCV) 89/89/fl, mean corpuscular hemoglobin (MCH) 31/30 pg/RBC, mean corpuscular hemoglobin concentration (MCHC) 34/34 g/dL, hematocrit (hct) 44/41%. Statistical evaluation revealed a slight but significant decrease in values over age decades for all parameters except for MCH. However, all values remained within the recommended German Society of Hematology and Oncology (DGHO) reference ranges. Hb values remained above the recommended World Health Organization (WHO) cut-offs for definition of anemia. Conclusions The results confirm the WHO reference values and are in accordance with the recommended DGHO reference values and previous results of other study cohorts outside Germany. There seems to be no need for establishing age-specific RBC or erythrocytic reference ranges for subjects >60 years.

Anemia in the aged is not ageing related: position paper on anemia in the aged by the “working group anemia” of the German Geriatric Society (DGG)

Anemia in the aged is a frequent but still under-estimated problem in geriatric patients. However, in recent years increasing research on anemia in the aged has improved awareness and interest in this clinically relevant problem. Guidelines for diagnostic and therapeutic steps are now required to improve the treatment of anemic aged patients. For encouraging the development of diagnostic and therapeutic recommendations, the “working group anemia” of the German Geriatric Society (DGG) has issued a position paper on anemia in the aged, based on the current literature. The statements are (1) that anemia has to be considered a highly prevalent but not a physiologic finding in aged persons; (2) that reference values for hemoglobin concentration are independent of age, indicating that WHO reference values for anemia definition are valid for aged persons; (3) that anemia in the aged is associated with functional and cognitive impairment based on comprehensive geriatric assessment (CGA), requiring diagnosis and treatment.

Serum hepcidin levels in geriatric patients with iron deficiency anemia or anemia of chronic diseases

BACKGROUND Iron deficiency anemia (IDA) and anemia of chronic diseases (ACD) are common in the geriatric population. However, differentiation between IDA and ACD is still problematic. Hepcidin is a key regulator of iron homeostasis: downregulation in the presence of iron deficiency allows enteral iron resorption, while upregulation in case of chronic inflammation blocks it. We aimed at studying whether serum hepcidin levels might serve as diagnostic parameter to differentiate between IDA and ACD among elderly. PATIENTS AND METHODS A total of 37 patients (age 69-97 years) were divided into 4 groups: group I (IDA), group II (ACD), group III (controls), and group IV (IDA/ACD). Serum hepcidin levels were analyzed using a commercially available ELISA kit (DRG Instruments, Marburg, Germany). Differences in hepcidin levels were tested with nonparametric methods. RESULTS We could show a strong positive correlation between serum hepcidin and ferritin (Spearman rho 0.747) and a statistic significant difference of hepcidin levels among all groups (p = 0.034). Hepcidin levels between ACD and controls differed significantly (p = 0.003). CONCLUSION Despite the small number of patients included in this study, which reduces the strength of the studys evidence, results conform with the current literature: it can be assumed that hepcidin will be used as a diagnostic parameter to differentiate between IDA and ACD in the future. However, more studies with larger patient groups are urgently needed to answer this question.

Serumhepcidin bei Eisenmangelanämie und Anämie chronischer Erkrankungen im geriatrischen Kollektiv

BACKGROUND Iron deficiency anemia (IDA) and anemia of chronic diseases (ACD) are common in the geriatric population. However, differentiation between IDA and ACD is still problematic. Hepcidin is a key regulator of iron homeostasis: downregulation in the presence of iron deficiency allows enteral iron resorption, while upregulation in case of chronic inflammation blocks it. We aimed at studying whether serum hepcidin levels might serve as diagnostic parameter to differentiate between IDA and ACD among elderly. PATIENTS AND METHODS A total of 37 patients (age 69-97 years) were divided into 4 groups: group I (IDA), group II (ACD), group III (controls), and group IV (IDA/ACD). Serum hepcidin levels were analyzed using a commercially available ELISA kit (DRG Instruments, Marburg, Germany). Differences in hepcidin levels were tested with nonparametric methods. RESULTS We could show a strong positive correlation between serum hepcidin and ferritin (Spearman rho 0.747) and a statistic significant difference of hepcidin levels among all groups (p = 0.034). Hepcidin levels between ACD and controls differed significantly (p = 0.003). CONCLUSION Despite the small number of patients included in this study, which reduces the strength of the studys evidence, results conform with the current literature: it can be assumed that hepcidin will be used as a diagnostic parameter to differentiate between IDA and ACD in the future. However, more studies with larger patient groups are urgently needed to answer this question.

Stationär behandelte geriatrische Patienten mit Eisenmangel-assoziiertem Restless-Legs-Syndrom

OBJECTIVE The Restless Legs Syndrome (RLS) is a clinically relevant condition in geriatric patients. An association between iron deficiency and RLS is largely acknowledged. The clinical and therapeutic management of iron deficiency-associated RLS has been, however, poorly evaluated in geriatric patients. METHODS Data from all RLS inpatients admitted to a geriatric unit between 2009 and 2011 were retrospectively collected on demographics and clinical characteristics, iron status, drug treatment including iron substitution, as well as comprehensive geriatric assessment (CGA) scores. RESULTS RLS was diagnosed in 56 of the 4,063 admitted patients during the two years. Of the RLS cases, 20 (36%) showed iron deficiency. Thirteen of these were treated with iron substitution according to the existing guidelines. Both RLS patients with and without iron deficiency showed a significant clinical improvement between admission to discharge according to the CGA scores. CONCLUSION Iron substituted geriatric patients with iron deficiency-associated RLS substantially benefited from the treatment, similarly to RLS patients without iron deficiency. A multidimensional assessment, careful iron metabolism examination and adequate treatment choice should be equally importantly considered in geriatric patients with RLS.ZusammenfassungHintergrundDas Restless-Legs-Syndrom (RLS) hat im Zusammenhang mit Eisenmangel klinische Relevanz im geriatrischen Klinikalltag. Die Datenlage zu Diagnostik und Therapie des Eisenmangel-assoziierten RLS (iron deficiency associated RLS, IDARLS) unter geriatrischen Patienten ist bisher jedoch limitiert.MethodenEs wurden Daten von allen zwischen 2009 und 2011 unter stationären Bedingungen behandelten Patienten einer geriatrischen Abteilung ausgewertet hinsichtlich demographischer und klinischer Charakteristika sowie hinsichtlich Eisenstatus, RLS-Medikation einschließlich Eisensubstitution und Ergebnissen des multidimensionalen geriatrischen Assessments (comprehensive geriatric assessment, CGA).ErgebnisseEin RLS wurde in 56 von 4.063 Patienten diagnostiziert, wobei 20 Patienten davon einen Eisenmangel aufwiesen. Davon erhielten 13 eine leitliniengemäße Eisensubstitution. Sowohl die Patienten mit IDARLS als auch die RLS-Patienten ohne Eisenmangel zeigten im Verlauf des stationär akutgeriatrischen Aufenthaltes eine klinisch signifikante Besserung der CGA-Ergebnisse.SchlussfolgerungEisensubstituierte, akutgeriatrische Patienten mit IDARLS zeigten vergleichbar gute Besserungen der CGA-Ergebnisse wie RLS-Patienten ohne Eisenmangel. Es erscheint sinnvoll, die Durchführung eines multidimensionalen geriatrischen Assessments sowie eine genaue Analyse des Eisenstatus mit ggf. notwendiger Substitution bei geriatrischen RLS-Patienten zu erwägen.AbstractObjectiveThe Restless Legs Syndrome (RLS) is a clinically relevant condition in geriatric patients. An association between iron deficiency and RLS is largely acknowledged. The clinical and therapeutic management of iron deficiency-associated RLS has been, however, poorly evaluated in geriatric patients.MethodsData from all RLS inpatients admitted to a geriatric unit between 2009 and 2011 were retrospectively collected on demographics and clinical characteristics, iron status, drug treatment including iron substitution, as well as comprehensive geriatric assessment (CGA) scores.ResultsRLS was diagnosed in 56 of the 4,063 admitted patients during the two years. Of the RLS cases, 20 (36%) showed iron deficiency. Thirteen of these were treated with iron substitution according to the existing guidelines. Both RLS patients with and without iron deficiency showed a significant clinical improvement between admission to discharge according to the CGA scores.ConclusionIron substituted geriatric patients with iron deficiency-associated RLS substantially benefited from the treatment, similarly to RLS patients without iron deficiency. A multidimensional assessment, careful iron metabolism examination and adequate treatment choice should be equally importantly considered in geriatric patients with RLS.