A multidimensional approach to the geriatric patient with chronic kidney disease

Abstract

The prognostic evaluation of elderly patients with chronic kidney disease (CKD) plays a key role in the decision analyses of care processes. It is increasingly evident that the prognosis of older patients with CKD is strongly affected by functional and cognitive status, body composition and nutrition, comorbidity and treatments and other factors that are not directly related to the index disease. The comprehensive geriatric assessment (CGA) is a multidimensional diagnostic process intended to determine an elderly person?s medical, functional and psychosocial capacity and problems, with the objective of developing an overall plan for treatment and follow-up. The potential usefulness of the CGA in evaluating treatment and follow-up of older patients with CKD is unknown. In this paper we reported the efficacy of the Multidimensional Prognostic Index (MPI), calculated from information collected by a standardized CGA, in predicting mortality risk in older patients hospitalized with CKD. The CGA included 6 standardized scales: Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), Mini Nutritional Assessment (MNA), Exton-Smith score (ESS) and Cumulative Index Rating Scale (CIRS), as well as information on medication history and cohabitation, for a total of 63 items. The MPI was calculated from the integrated total scores and expressed as MPI 1 = low risk, MPI 2 = moderate risk and MPI 3 = severe risk of mortality. Higher MPI values were significantly associated with higher 1-year mortality in older patients with CKD. Moreover, MPI showed a greater discriminatory power than organ-specific prognostic indexes such as the estimated glomerular filtration rate. All of these findings support the concept that a multidimensional approach may be appropriate for the evaluation of older patients with CKD, as has been reported for patients with other pathological conditions.