Association between Multidimensional Prognostic Index and Hospitalization and Mortality among Older Adults with Chronic Kidney Disease on Conservative or on Replacement Therapy

Abstract

The prevalence of renal disease is constantly increasing in older adults and a prognostic evaluation by a valid tool may play a key role in treatment management. We aimed to assess the association(s) between the multidimensional prognostic index (MPI) and both the hospitalization and mortality among older adults with renal disease. Patients with chronic kidney disease (CKD) (stage 3–5 KDOQI) and on dialysis were considered. Clinical parameters were registered at baseline and after 2 years. In all the patients, the MPI was calculated and divided into grade 0 (low risk), 1 (moderate risk), and 2 (severe risk). Hospitalizations and mortality were recorded during the follow-up and analyzed according to MPI grade. A total of 173 patients, with a median age of 76 years, on conservative (n = 105) and replacement therapy (32 patients on hemodialysis, 36 patients on peritoneal dialysis) were enrolled. Of them, 60 patients were in MPI grade 0, 102 in grade 1, and 11 in grade 2. The median duration of all the hospitalizations was 6 days and the number of deaths was 33. MPI significantly correlated with days of hospitalization (r = 0.801, p < 0.00001) and number of hospitalizations per year (r = 0.808, p < 0.00001), which was higher in MPI grade 2 compared to grade 1 (p < 0.001) and to grade 0 (p < 0.001). We found a significant association between MPI grades and mortality (p < 0.001). Our results indicate that MPI was associated with outcomes in patients with renal disease, suggesting that a multidimensional evaluation should be implemented in this clinical setting.

Multidimensional frailty increases cardiovascular risk in older people: An 8-year longitudinal cohort study in the Osteoarthritis Initiative

“…11 Among all indexes available in geriatric medicine for clinical-decision making, the MPI is the only index obtained from a CGA exploring comprehensively several domains, including health, functional, cognitive, and nutritional parameters, as well as social aspects, using standardized and extensively validated rating scales. 12 A large body of literature has shown that MPI is significantly and strongly associated with several negative outcomes in older people, such as mortality and (re)hospitalization 9,10,[13][14][15][16][17][18][19] , but also other conditions, such as poor quality of life 20 and depression. 21 However, to the best of our knowledge, no study has explored the relationship between MPI values and risk of CVD.…”

Biomarkers of aging in real life: three questions on aging and the comprehensive geriatric assessment

“…No effect on admission to ICU [ 86 ]. Frailty, identified by MPI, was associated with mortality [ 87 ] SARS-CoV-2 infection in nursing homes (NH) [ 88 ] Retrospective propensity score-adjusted study of 3946 older NH residents with or without COVID-19 Mortality Increasing MPI associated with higher rates of mortality Oncology Colorectal cancer [ 89 ] Observational longitudinal of 104 older patients receiving surgery 90-day postoperative complications MPI was associated with major postoperative complications Advanced cancer [ 90 ] Observational longitudinal of 79 older patients receiving immunotherapy Rate of survival MPI predicted rate of survival Nephrology Chronic kidney disease (CKD) III-V [ 91 ] and CKD [ 92 ] Observational longitudinal studies of 173 patients ≥ 65 years receiving dialysis or conservative therapy [ 91 ], and 1198 patients ≥ 65 years with a diagnosis of CKD [ 92 ] Hospitalization and 24-month survival MPI was associated with days of hospitalization and rate of survival [ 91 ]. Adding MPI to eGFR predicted mortality more accurately [ 92 ] Cognitive disorders Dementia [ 93 ] Observational retrospective study of 6818 older community-dwellers dementia patients treated with anti-cholinesterasics or memantine VS no treatment 2-year mortality Antidementia treatment was associated with reduced mortality in the MPI-1 and MPI-2 groups, but not in the MPI-3 group Depression [ 46 , 65 , 94 ] Longitudinal study of 1854 adults ≥ 65 years without depressive symptoms at baseline [ 65 ]; prospective study of 81 adults ≥ 60 years who underwent orthopedic surgery of the lower limb [ 46 …”

The Relationship between Serum Selenium Levels and Restless Leg Syndrome in Chronic Kidney Disease Patients

“…End-stage renal disease (ESRD) is the final stage of chronic kidney disease (CKD), characterized by a significant loss of kidney function. It is a severe and irreversible condition that requires renal replacement therapy (RRT) to sustain life [2]. ESRD is associated with a range of complications and comorbidities, including cardiovascular disease, depression, malnutrition, and increased mortality [2,3].…”

“…It is a severe and irreversible condition that requires renal replacement therapy (RRT) to sustain life [2]. ESRD is associated with a range of complications and comorbidities, including cardiovascular disease, depression, malnutrition, and increased mortality [2,3].…”

“…The prevalence and incidence of ESRD have been rapidly increasing worldwide, with an estimated 2.6 million patients receiving RRT in 2010, projected to rise to 5.4 million by 2030 [2].…”