Skip to content

LEARN-6™: A Prospective, Observational Nursing Home Study

Prospective Observational Study to Evaluate Physical Performance and Quality of Life in Older Long Stay Nursing Home Residents With Chronic Kidney Disease With and Without Anemia

Status
Completed
Phases
Unknown
Study type
Observational
Source
ClinicalTrials.gov
Registry ID
NCT00727571
Enrollment
815
Registered
2008-08-04
Start date
2006-09-30
Completion date
2008-07-31
Last updated
2014-07-25

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Anemia, Chronic Kidney Disease

Keywords

Anemia, Chronic Kidney Disease, Quality of Life, CKD, Chronic Renal Insufficiency

Brief summary

This is a prospective, multicenter, observational, hypothesis-generating study exploring mobility, Quality of Life and other physical performance measures among older, long-term stay Nursing Home residents with CKD, with versus without anemia. Enrolled patients will participate in the study up to a total of 26 weeks and be assessed at Weeks 1, 2, 14 and 26/End of Study. Based upon Week 1 hemoglobin and serum creatinine lab results, participants will be categorized into 1 of 4 groups.

Detailed description

Study Design: Multicenter, non-interventional, 26-week, prospective, observational study of older, long-term stay residents with CKD, with and without anemia, in US Nursing Homes.

Interventions

This is a non-interventional, observational study; no investigational product is being used

Sponsors

Amgen
Lead SponsorINDUSTRY

Study design

Time perspective
PROSPECTIVE

Eligibility

Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes

Inclusion criteria

* Age \> 65 years * Long-term resident of NH as documented in medical record by Director of Nursing (DON) or Medical Director or as indicated in Minimum Data Set (MDS) Section Q * Able to walk at least 1 step or propel wheelchair 1 revolution of wheel * Able to follow a one-step instruction * Written informed consent

Exclusion criteria

* Admitted to NH for short stay rehabilitation (anticipated stay less than 3 months) * Receiving Renal Replacement Therapy (RRT) * Major surgery within the past 3 months * Life expectancy \< 6 months or receiving palliative care * Currently enrolled in or has not yet completed at least 30 days since ending investigational device or drug study(s), or is receiving investigational agent(s) * Currently is enrolled in an interventional trial * Previously withdrawn from this study

Design outcomes

Primary

MeasureTime frameDescription
Total Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeeks 2, 14 and 26The distance a participant walked, with or without an assistive device and stand-by assistance of 1 person, or propelled him/herself in a wheelchair with or without the use of his/her feet, over level ground, during a period of up to 10 minutes including up to two 30-second rest periods (at weeks 2, 14 and 26).

Secondary

MeasureTime frameDescription
Percentage of Participants With Anemia Related Conditions at BaselineBaselineThe percentages of anemic subjects with iron deficiency, vitamin B12 deficiency, gastrointestinal (GI) bleed, chronic inflammation, and folate deficiency. Anemia of iron deficiency is defined as reduced serum iron, reduced transferrin saturation, ferritin less than 12 ng/mL plus increased Total Iron Binding Capacity (TIBC), per normal laboratory range. Anemia of chronic inflammation defined as reduced serum iron and transferrin saturation, increased or normal ferritin, and reduced or normal TIBC. GI bleed is based on the result of the stool guaiac sample(s) collected: A participant is considered to have GI bleed if one guaiac sample is positive, and not to have GI bleed only if all of his/her three stool guaiac samples were negative. Vitamin B12 and folate deficiency based on standard laboratory ranges.
Estimated Glomerular Filtration Rate (GFR) for Participants With CKDWeeks 1, 14 and 26Estimated GFR measures how much blood the kidneys are filtering, and was calculated using 2 methods: 1. Modification of Diet in Renal Disease study (MDRD) formula: estimated GFR = 186 x \[Serum creatinine\]\^-1.154 x \[Age\]\^-0.203 x \[0.742 if patient is female\] x \[1.210 if patient is black\]. 2. Cockcroft-Gault formula: GFR = (140-age) \* (Weight in kg) \* (0.85 if female) / (72 \* Serum Creatinine).
Physical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeeks 2, 14 and 26Physical performance was measured for all patients with CKD (defined as estimated Glomerular Filtration Rate (eGFR) \<60 mL/min/1.73m\^2). The average speed a participant walked, with or without an assistive device, and stand-by assistance of one person or propelled themselves in their wheelchair with or without the use of their feet, over level ground, up to 10 minutes with up to two 30 second rest periods.
Physical Performance: Duration Walked or Wheeled at Each VisitWeeks 2, 14, 26The duration a participant was able to walk or propel themselves in a wheelchair during 10 minutes.
Number of Participants With AnemiaBaselineAnemia is defined using World Health Organization (WHO) criteria as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men.
Physical Performance: Grip StrengthWeeks 2, 14, 26Grip strength was measured using an adjustable, hand-held, hydraulic grip strength dynamometer. While seated, participants were asked to grip the 2 bars of the dynamometer in their hand and slowly squeeze as hard as they can; then relax. The highest of three measurements was recorded.
Physical Performance: Lower Extremity Strength, Left Leg.Weeks 2, 14, 26Lower extremity strength test measures the maximum amount of weight a participant can lift one time throughout his/her range of motion. While supine, and using adjustable cuff weights, participants were asked to bend at their hip and knee and draw their heel along the bed towards their buttocks.
Physical Performance: Lower Extremity Strength, Right LegWeeks 2, 14, 26Lower extremity strength test measures the maximum amount of weight a participant can lift one time throughout his/her range of motion. While supine, and using adjustable cuff weights, participants were asked to bend at their hip and knee and draw their heel along the bed towards their buttocks.
Physical Performance: Time to Rise From Sitting to StandingWeeks 2, 14, 26Participants were asked to stand from a seated position so that knees approximated full extension. Timing began from the point that the participant initiated the standing behavior to the point he/she was on his/her feet with knees at approximately full extension.

Participant flow

Pre-assignment details

815 patients were enrolled; 21 of these could not be classified into the defined groups because of missing lab values at enrollment. Their anemic/CKD status is therefore not available.

Participants by arm

ArmCount
No CKD, But Anemia
CKD is based on estimated GFR calculated by the MDRD method of \< 60 mL/min/1.73m\^2. Anemia is defined as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men per WHO criteria.
169
No CKD or Anemia
CKD is based on estimated GFR, calculated by the MDRD method, of \< 60 mL/min/1.73m\^2. Anemia is defined as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men per WHO criteria.
232
CKD With Anemia
CKD is based on estimated GFR calculated by the MDRD method of \< 60 mL/min/1.73m\^2. Anemia is defined as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men per WHO criteria.
228
CKD With no Anemia
CKD is based on estimated GFR calculated by the MDRD method of \< 60 mL/min/1.73m\^2. Anemia is defined as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men per WHO criteria.
165
Total794

Withdrawals & dropouts

PeriodReasonFG000FG001FG002FG003
Overall StudyAE not leading to hospitalization0020
Overall StudyDeath01951
Overall StudyDismissed from nursing home0950
Overall StudyHospitalization0101
Overall StudyIneligibility determined1110
Overall StudyOther0460
Overall StudyPhysician Decision0500
Overall StudySubject Non Compliance0604
Overall StudyWithdrawal by Subject010110

Baseline characteristics

CharacteristicNo CKD, But AnemiaNo CKD or AnemiaCKD With AnemiaCKD With no AnemiaTotal
Age, Continuous82.6 Years
STANDARD_DEVIATION 8.3
81.6 Years
STANDARD_DEVIATION 8.2
84.6 Years
STANDARD_DEVIATION 8.1
83.8 Years
STANDARD_DEVIATION 8.4
83.1 Years
STANDARD_DEVIATION 8.3
Sex: Female, Male
Female
88 Participants172 Participants159 Participants139 Participants558 Participants
Sex: Female, Male
Male
81 Participants60 Participants69 Participants26 Participants236 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
EG003
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —— / —
other
Total, other adverse events
0 / 00 / 00 / 00 / 0
serious
Total, serious adverse events
0 / 00 / 00 / 00 / 0

Outcome results

Primary

Total Distance Walked or Wheeled in a Maximum of 10 Minutes at Each Visit

The distance a participant walked, with or without an assistive device and stand-by assistance of 1 person, or propelled him/herself in a wheelchair with or without the use of his/her feet, over level ground, during a period of up to 10 minutes including up to two 30-second rest periods (at weeks 2, 14 and 26).

Time frame: Weeks 2, 14 and 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEDIAN)
CKD With AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 2 (N=209, 152)210.0 feet
CKD With AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 14 (N=173, 134)210.0 feet
CKD With AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 26 (N=158, 124)185.0 feet
CKD With no AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 14 (N=173, 134)246.5 feet
CKD With no AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 2 (N=209, 152)253.1 feet
CKD With no AnemiaTotal Distance Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 26 (N=158, 124)198.5 feet
Secondary

Estimated Glomerular Filtration Rate (GFR) for Participants With CKD

Estimated GFR measures how much blood the kidneys are filtering, and was calculated using 2 methods: 1. Modification of Diet in Renal Disease study (MDRD) formula: estimated GFR = 186 x \[Serum creatinine\]\^-1.154 x \[Age\]\^-0.203 x \[0.742 if patient is female\] x \[1.210 if patient is black\]. 2. Cockcroft-Gault formula: GFR = (140-age) \* (Weight in kg) \* (0.85 if female) / (72 \* Serum Creatinine).

Time frame: Weeks 1, 14 and 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 1 - MDRD (N=228, 165)42.1 mL/min/1.73 m^2Standard Deviation 10.6
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 26 - MDRD (N=169, 132)45.2 mL/min/1.73 m^2Standard Deviation 15.3
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 26 - CG (N=167, 132)37.4 mL/min/1.73 m^2Standard Deviation 15.6
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 1 - CG (N=224, 165)35.0 mL/min/1.73 m^2Standard Deviation 13.9
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 14 - MDRD (N=183, 143)42.6 mL/min/1.73 m^2Standard Deviation 11.6
CKD With AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 14 - CG (N=181, 143)35.9 mL/min/1.73 m^2Standard Deviation 15.2
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 14 - MDRD (N=183, 143)48.0 mL/min/1.73 m^2Standard Deviation 15
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 26 - CG (N=167, 132)41.8 mL/min/1.73 m^2Standard Deviation 16.8
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 1 - MDRD (N=228, 165)44.9 mL/min/1.73 m^2Standard Deviation 9.9
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 14 - CG (N=181, 143)41.6 mL/min/1.73 m^2Standard Deviation 16.9
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 26 - MDRD (N=169, 132)48.0 mL/min/1.73 m^2Standard Deviation 13.5
CKD With no AnemiaEstimated Glomerular Filtration Rate (GFR) for Participants With CKDWeek 1 - CG (N=224, 165)39.6 mL/min/1.73 m^2Standard Deviation 15.7
Secondary

Number of Participants With Anemia

Anemia is defined using World Health Organization (WHO) criteria as Hemogloblin \<12 g/dL in women, \< 13 g/dL in men.

Time frame: Baseline

Population: All enrolled patients with available anemia lab results.

ArmMeasureValue (NUMBER)
CKD With AnemiaNumber of Participants With Anemia397 participants
Secondary

Percentage of Participants With Anemia Related Conditions at Baseline

The percentages of anemic subjects with iron deficiency, vitamin B12 deficiency, gastrointestinal (GI) bleed, chronic inflammation, and folate deficiency. Anemia of iron deficiency is defined as reduced serum iron, reduced transferrin saturation, ferritin less than 12 ng/mL plus increased Total Iron Binding Capacity (TIBC), per normal laboratory range. Anemia of chronic inflammation defined as reduced serum iron and transferrin saturation, increased or normal ferritin, and reduced or normal TIBC. GI bleed is based on the result of the stool guaiac sample(s) collected: A participant is considered to have GI bleed if one guaiac sample is positive, and not to have GI bleed only if all of his/her three stool guaiac samples were negative. Vitamin B12 and folate deficiency based on standard laboratory ranges.

Time frame: Baseline

Population: Enrolled patients with anemia

ArmMeasureGroupValue (NUMBER)
CKD With AnemiaPercentage of Participants With Anemia Related Conditions at BaselineVitamin B12 deficiency2.6 Percentage of participants
CKD With AnemiaPercentage of Participants With Anemia Related Conditions at BaselineChronic inflammation21.9 Percentage of participants
CKD With AnemiaPercentage of Participants With Anemia Related Conditions at BaselineGastrointestinal (GI) Bleed11.4 Percentage of participants
CKD With AnemiaPercentage of Participants With Anemia Related Conditions at BaselineFolate deficiency2.2 Percentage of participants
CKD With AnemiaPercentage of Participants With Anemia Related Conditions at BaselineIron deficiency0.0 Percentage of participants
CKD With no AnemiaPercentage of Participants With Anemia Related Conditions at BaselineFolate deficiency4.1 Percentage of participants
CKD With no AnemiaPercentage of Participants With Anemia Related Conditions at BaselineIron deficiency0.0 Percentage of participants
CKD With no AnemiaPercentage of Participants With Anemia Related Conditions at BaselineVitamin B12 deficiency5.3 Percentage of participants
CKD With no AnemiaPercentage of Participants With Anemia Related Conditions at BaselineGastrointestinal (GI) Bleed10.1 Percentage of participants
CKD With no AnemiaPercentage of Participants With Anemia Related Conditions at BaselineChronic inflammation18.3 Percentage of participants
Secondary

Physical Performance: Duration Walked or Wheeled at Each Visit

The duration a participant was able to walk or propel themselves in a wheelchair during 10 minutes.

Time frame: Weeks 2, 14, 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 2 (N=208, 152)6.4 minutesStandard Deviation 3.3
CKD With AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 14 (N=173, 133)6.5 minutesStandard Deviation 3.1
CKD With AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 26 (N=158, 124)6.6 minutesStandard Deviation 3.1
CKD With no AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 2 (N=208, 152)6.2 minutesStandard Deviation 3.1
CKD With no AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 14 (N=173, 133)6.4 minutesStandard Deviation 3.2
CKD With no AnemiaPhysical Performance: Duration Walked or Wheeled at Each VisitWeek 26 (N=158, 124)6.0 minutesStandard Deviation 3.2
Secondary

Physical Performance: Grip Strength

Grip strength was measured using an adjustable, hand-held, hydraulic grip strength dynamometer. While seated, participants were asked to grip the 2 bars of the dynamometer in their hand and slowly squeeze as hard as they can; then relax. The highest of three measurements was recorded.

Time frame: Weeks 2, 14, 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaPhysical Performance: Grip StrengthWeek 2 (N=215, 154)29.6 pound-forceStandard Deviation 17.4
CKD With AnemiaPhysical Performance: Grip StrengthWeek 14 (N=182, 140)29.8 pound-forceStandard Deviation 17.3
CKD With AnemiaPhysical Performance: Grip StrengthWeek 26 (N=166, 129)29.0 pound-forceStandard Deviation 16.9
CKD With no AnemiaPhysical Performance: Grip StrengthWeek 2 (N=215, 154)31.8 pound-forceStandard Deviation 16.9
CKD With no AnemiaPhysical Performance: Grip StrengthWeek 14 (N=182, 140)32.5 pound-forceStandard Deviation 17.1
CKD With no AnemiaPhysical Performance: Grip StrengthWeek 26 (N=166, 129)29.8 pound-forceStandard Deviation 17.4
Secondary

Physical Performance: Lower Extremity Strength, Left Leg.

Lower extremity strength test measures the maximum amount of weight a participant can lift one time throughout his/her range of motion. While supine, and using adjustable cuff weights, participants were asked to bend at their hip and knee and draw their heel along the bed towards their buttocks.

Time frame: Weeks 2, 14, 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 2 (N=211, 151)5.3 poundsStandard Deviation 4.1
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 14 (N=174, 136)5.3 poundsStandard Deviation 4.4
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 26 (N=159, 125)5.6 poundsStandard Deviation 4.5
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 2 (N=211, 151)6.1 poundsStandard Deviation 4.1
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 14 (N=174, 136)6.6 poundsStandard Deviation 4.6
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Left Leg.Week 26 (N=159, 125)6.4 poundsStandard Deviation 4.5
Secondary

Physical Performance: Lower Extremity Strength, Right Leg

Lower extremity strength test measures the maximum amount of weight a participant can lift one time throughout his/her range of motion. While supine, and using adjustable cuff weights, participants were asked to bend at their hip and knee and draw their heel along the bed towards their buttocks.

Time frame: Weeks 2, 14, 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 2 (N= 212, 151)5.3 poundsStandard Deviation 4
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 14 (N=174, 136)5.2 poundsStandard Deviation 4
CKD With AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 26 (N=159, 125)5.6 poundsStandard Deviation 4.5
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 26 (N=159, 125)6.5 poundsStandard Deviation 4.5
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 2 (N= 212, 151)6.3 poundsStandard Deviation 4
CKD With no AnemiaPhysical Performance: Lower Extremity Strength, Right LegWeek 14 (N=174, 136)6.1 poundsStandard Deviation 4.1
Secondary

Physical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each Visit

Physical performance was measured for all patients with CKD (defined as estimated Glomerular Filtration Rate (eGFR) \<60 mL/min/1.73m\^2). The average speed a participant walked, with or without an assistive device, and stand-by assistance of one person or propelled themselves in their wheelchair with or without the use of their feet, over level ground, up to 10 minutes with up to two 30 second rest periods.

Time frame: Weeks 2, 14 and 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEAN)Dispersion
CKD With AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 2 (N=208, 152)51.2 feet per minuteStandard Deviation 40.4
CKD With AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 14 (N=172, 132)51.0 feet per minuteStandard Deviation 41.6
CKD With AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 26 (N=158, 123)49.9 feet per minuteStandard Deviation 42.2
CKD With no AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 2 (N=208, 152)61.9 feet per minuteStandard Deviation 51.4
CKD With no AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 14 (N=172, 132)70.1 feet per minuteStandard Deviation 59
CKD With no AnemiaPhysical Performance: Speed Walked or Wheeled in a Maximum of 10 Minutes at Each VisitWeek 26 (N=158, 123)66.5 feet per minuteStandard Deviation 62.3
Secondary

Physical Performance: Time to Rise From Sitting to Standing

Participants were asked to stand from a seated position so that knees approximated full extension. Timing began from the point that the participant initiated the standing behavior to the point he/she was on his/her feet with knees at approximately full extension.

Time frame: Weeks 2, 14, 26

Population: Enrolled patients with CKD and non-missing data at each time point (indicated by N).

ArmMeasureGroupValue (MEDIAN)
CKD With AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 2 (N=171, 133)3.0 seconds
CKD With AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 14 (N=134, 114)2.5 seconds
CKD With AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 26 (N=125, 108)3.0 seconds
CKD With no AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 2 (N=171, 133)3.0 seconds
CKD With no AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 14 (N=134, 114)3.0 seconds
CKD With no AnemiaPhysical Performance: Time to Rise From Sitting to StandingWeek 26 (N=125, 108)3.0 seconds

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026