Learn about the
2008T Fresenius Hemodialysis

Interview with
Jeffrey H. Burbank
Founder& CEO of NxStage

Publication:

Addition of the multidimensional prognostic index to the estimated glomerular filtration rate improves prediction of long-term all-cause mortality in older patients with chronic kidney disease.

Recently, a Multidimensional Prognostic Index (MPI) for all-cause mortality, based on a standard comprehensive geriatric assessment including information on clinical, functional, cognitive, nutritional, social status, comorbidity and drug use, has been developed and validated in different  cohorts of  hospitalized older patients with acute and chronic diseases.

This study demonstrated that the MPI was a very good predictor of all-cause mortality in patients older than 65 years hospitalized with chronic kidney disease (CKD). Moreover, adding MPI information to the estimated glomerular filtration rate (eGFR) markedly and significantly improved the prediction of 2-year all-cause mortality in these hospitalized older patients with CKD.

Were any of the findings unexpected?

Recent research suggested that the prognosis of older patients with chronic medical conditions is strongly affected by a multiplicity of functional, cognitive, nutritional and social factors that are not directly related to their primary disease, indicating that the prognostic model for mortality for these patients should be multidimensional in nature rather than disease specific.

Recently, the Multidimensional Prognostic Index (MPI) for all-cause mortality, based on information on clinical, functional, cognitive, nutritional, social status, comorbidity and drug use, has been validated in older patients with several acute and chronic diseases, including CKD.

However, the prognostic accuracy of the MPI in comparison with and in addition to the eGFR to predict long-term all-cause mortality in older patients with CKD was unknown.

What should clinicians and patients take away from this study?

Results of this study suggest that inclusion of information collected by a multidimensional approach, i.e. the MPI, should be used to evaluate prognosis and need for medical surveillance in older patients with CKD.

What recommendations do you have for future studies as a result of your study?

Since the inclusion of multidimensional information of older patients, as expressed by the MPI, markedly improves the predictive accuracy for long-term all-cause mortality of the eGFR, results of this study suggest that a multidimensional evaluation for all-cause mortality risk prediction should be considered in older patients with CKD.