IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
J Nephrol. 2010 Sep-Oct;23 Suppl 15:S5-10.
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.
慢性肾脏病（CKD）老年患者的预后评估在治疗方案的决策分析中起着关键作用。越来越明显的是，CKD 老年患者的预后受到功能和认知状态、身体成分和营养、合并症和治疗以及其他与指数疾病不直接相关的因素的强烈影响。综合老年评估（CGA）是一种多维诊断过程，旨在确定老年人的医疗、功能和社会心理能力和问题，目的是制定整体治疗和随访计划。CGA 在评估 CKD 老年患者的治疗和随访中的潜在有用性尚不清楚。在本文中，我们报告了从标准化 CGA 收集的信息中计算出的多维预后指数（MPI）在预测 CKD 住院老年患者死亡风险方面的疗效。CGA 包括 6 个标准化量表：日常生活活动（ADL）、工具性日常生活活动（IADL）、简短便携精神状态问卷（SPMSQ）、微型营养评估（MNA）、埃克斯顿-史密斯评分（ESS）和累积指数评分量表（CIRS），以及药物治疗史和同居情况，共 63 项。MPI 是从综合总评分中计算出来的，表达为 MPI1=低风险、MPI2=中风险和 MPI3=高死亡风险。更高的 MPI 值与 CKD 老年患者更高的 1 年死亡率显著相关。此外，MPI 比特定器官的预后指标（如估计肾小球滤过率）具有更高的鉴别能力。所有这些发现都支持这样一种概念，即多维方法可能适合评估 CKD 老年患者，正如其他病理情况患者的报道一样。
