Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease

Alberto Pilotto, Francesco Panza, Daniele Sancarlo, Giulia Paroni, Stefania Maggi, Luigi Ferrucci

Research output: Contribution to journalArticle

Abstract

In older patients, given the central role of prognosis in clinical decision-making, there is an urgent need to develop accurate, validated, and rigorously tested prognostic indices. Current data suggest that in older patients not only physical but also psychological, cognitive, functional, nutritional, biological, and social factors may contribute to the increased risk of negative outcomes including institutionalization, hospital-ization, and mortality. Recently, a Multidimensional Prognostic Index (MPI), derived from a standardized comprehensive geriatric assessment that included information from eight domains, i.e. basal and instrumental activities of daily living, cognitive and nutritional status, the risk for pressure sores, comorbidi-ties, drug use, and co-habitation status was effective in predicting short- and long-term all-cause mortality risk in hospitalized patients with various acute and chronic conditions, including chronic kidney disease (CKD). In a consecutive cohort of patients with CKD the MPI accuracy in predicting mortality was significantly higher than the accuracy of the estimated glo-merular filtration rate (eGFR). More recently, findings from hospital-based cohorts suggest that adding MPI information to the eGFR markedly improved the prediction of two-year all-cause mortality in older patients with CKD. While further studies are needed to assess the potential usefulness of this prognostic tool in clinical practice, a multidimensional assessment for all-cause mortality risk prediction should be considered in older patients with CKD. These findings support the concept that considering multidimensional aggregate information is very important for predicting short- and long-term all-cause mortality in older subjects with CKD, and that it may be important for the identification of more suitable management of these patients.

Original languageEnglish (US)
JournalJournal of Nephrology
Volume25
Issue numberSUPPL.19
DOIs
StatePublished - 2012
Externally publishedYes

Fingerprint

Chronic Renal Insufficiency
Mortality
Geriatric Assessment
Institutionalization
Pressure Ulcer
Biological Factors
Activities of Daily Living
Hospital Mortality
Nutritional Status
Psychology
Pharmaceutical Preparations

Keywords

  • Aging
  • All-cause mortality
  • Chronic kidney disease
  • Comprehensive geriatric assessment
  • Elderly
  • Multidimensional prognostic index

ASJC Scopus subject areas

  • Nephrology

Cite this

Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease. / Pilotto, Alberto; Panza, Francesco; Sancarlo, Daniele; Paroni, Giulia; Maggi, Stefania; Ferrucci, Luigi.

In: Journal of Nephrology, Vol. 25, No. SUPPL.19, 2012.

Research output: Contribution to journalArticle

Pilotto, Alberto ; Panza, Francesco ; Sancarlo, Daniele ; Paroni, Giulia ; Maggi, Stefania ; Ferrucci, Luigi. / Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease. In: Journal of Nephrology. 2012 ; Vol. 25, No. SUPPL.19.
@article{a3d0a0e4e3c6444782b3ac92897677df,
title = "Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease",
abstract = "In older patients, given the central role of prognosis in clinical decision-making, there is an urgent need to develop accurate, validated, and rigorously tested prognostic indices. Current data suggest that in older patients not only physical but also psychological, cognitive, functional, nutritional, biological, and social factors may contribute to the increased risk of negative outcomes including institutionalization, hospital-ization, and mortality. Recently, a Multidimensional Prognostic Index (MPI), derived from a standardized comprehensive geriatric assessment that included information from eight domains, i.e. basal and instrumental activities of daily living, cognitive and nutritional status, the risk for pressure sores, comorbidi-ties, drug use, and co-habitation status was effective in predicting short- and long-term all-cause mortality risk in hospitalized patients with various acute and chronic conditions, including chronic kidney disease (CKD). In a consecutive cohort of patients with CKD the MPI accuracy in predicting mortality was significantly higher than the accuracy of the estimated glo-merular filtration rate (eGFR). More recently, findings from hospital-based cohorts suggest that adding MPI information to the eGFR markedly improved the prediction of two-year all-cause mortality in older patients with CKD. While further studies are needed to assess the potential usefulness of this prognostic tool in clinical practice, a multidimensional assessment for all-cause mortality risk prediction should be considered in older patients with CKD. These findings support the concept that considering multidimensional aggregate information is very important for predicting short- and long-term all-cause mortality in older subjects with CKD, and that it may be important for the identification of more suitable management of these patients.",
keywords = "Aging, All-cause mortality, Chronic kidney disease, Comprehensive geriatric assessment, Elderly, Multidimensional prognostic index",
author = "Alberto Pilotto and Francesco Panza and Daniele Sancarlo and Giulia Paroni and Stefania Maggi and Luigi Ferrucci",
year = "2012",
doi = "10.5301/jn.5000162",
language = "English (US)",
volume = "25",
journal = "Journal of Nephrology",
issn = "1121-8428",
publisher = "Wichtig Publishing",
number = "SUPPL.19",

}

TY - JOUR

T1 - Usefulness of the multidimensional prognostic index (MPI) in the management of older patients with chronic kidney disease

AU - Pilotto, Alberto

AU - Panza, Francesco

AU - Sancarlo, Daniele

AU - Paroni, Giulia

AU - Maggi, Stefania

AU - Ferrucci, Luigi

PY - 2012

Y1 - 2012

N2 - In older patients, given the central role of prognosis in clinical decision-making, there is an urgent need to develop accurate, validated, and rigorously tested prognostic indices. Current data suggest that in older patients not only physical but also psychological, cognitive, functional, nutritional, biological, and social factors may contribute to the increased risk of negative outcomes including institutionalization, hospital-ization, and mortality. Recently, a Multidimensional Prognostic Index (MPI), derived from a standardized comprehensive geriatric assessment that included information from eight domains, i.e. basal and instrumental activities of daily living, cognitive and nutritional status, the risk for pressure sores, comorbidi-ties, drug use, and co-habitation status was effective in predicting short- and long-term all-cause mortality risk in hospitalized patients with various acute and chronic conditions, including chronic kidney disease (CKD). In a consecutive cohort of patients with CKD the MPI accuracy in predicting mortality was significantly higher than the accuracy of the estimated glo-merular filtration rate (eGFR). More recently, findings from hospital-based cohorts suggest that adding MPI information to the eGFR markedly improved the prediction of two-year all-cause mortality in older patients with CKD. While further studies are needed to assess the potential usefulness of this prognostic tool in clinical practice, a multidimensional assessment for all-cause mortality risk prediction should be considered in older patients with CKD. These findings support the concept that considering multidimensional aggregate information is very important for predicting short- and long-term all-cause mortality in older subjects with CKD, and that it may be important for the identification of more suitable management of these patients.

AB - In older patients, given the central role of prognosis in clinical decision-making, there is an urgent need to develop accurate, validated, and rigorously tested prognostic indices. Current data suggest that in older patients not only physical but also psychological, cognitive, functional, nutritional, biological, and social factors may contribute to the increased risk of negative outcomes including institutionalization, hospital-ization, and mortality. Recently, a Multidimensional Prognostic Index (MPI), derived from a standardized comprehensive geriatric assessment that included information from eight domains, i.e. basal and instrumental activities of daily living, cognitive and nutritional status, the risk for pressure sores, comorbidi-ties, drug use, and co-habitation status was effective in predicting short- and long-term all-cause mortality risk in hospitalized patients with various acute and chronic conditions, including chronic kidney disease (CKD). In a consecutive cohort of patients with CKD the MPI accuracy in predicting mortality was significantly higher than the accuracy of the estimated glo-merular filtration rate (eGFR). More recently, findings from hospital-based cohorts suggest that adding MPI information to the eGFR markedly improved the prediction of two-year all-cause mortality in older patients with CKD. While further studies are needed to assess the potential usefulness of this prognostic tool in clinical practice, a multidimensional assessment for all-cause mortality risk prediction should be considered in older patients with CKD. These findings support the concept that considering multidimensional aggregate information is very important for predicting short- and long-term all-cause mortality in older subjects with CKD, and that it may be important for the identification of more suitable management of these patients.

KW - Aging

KW - All-cause mortality

KW - Chronic kidney disease

KW - Comprehensive geriatric assessment

KW - Elderly

KW - Multidimensional prognostic index

UR - http://www.scopus.com/inward/record.url?scp=84872013092&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872013092&partnerID=8YFLogxK

U2 - 10.5301/jn.5000162

DO - 10.5301/jn.5000162

M3 - Article

VL - 25

JO - Journal of Nephrology

JF - Journal of Nephrology

SN - 1121-8428

IS - SUPPL.19

ER -