Capacidad diagnóstica de las ecuaciones Chronic Kidney Disease Epidemiology Collaboration y Modification of Diet in Renal Disease-4 en la estimación del filtrado glomerular en pacientes pluripatológicos / Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients

Fundamento y objetivo: La fórmula Modification of Diet in Renal Disease (MDRD) es la recomendada por la mayoría de las sociedades científicas para el cálculo del filtrado glomerular estimado (FGe). Recientemente el grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) ha publicado una nueva ecuación con mayor exactitud y precisión. Hemos analizado su comportamiento en un grupo de pacientes pluripatológicos (PP) comparándola con la versión clásica MDRD-4. Pacientes y método: Estudio multicéntrico, observacional, descriptivo y transversal. Se calculó el FGe por MDRD-4 y CKD-EPI en 425 PP. A cada uno se le asignó un estadio según su FGe: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; y 5: < 15 ml/min/1,73m2. Se analizó la concordancia entre ambas y la reclasificación de pacientes por CKD-EPI. Resultados: La edad media (DE) fue de 81,7 (7,9) años. El 55,3% eran mujeres. La media del FGe fue de 58,6 (26,3) ml/min/1,73m2 según MDRD-4 y de 52,7 (23,0) ml/min/1,73m2 según CKD-EPI (p < 0,001; coeficientes de correlación Rho de Spearman y de concordancia de Lin: 0,993 y 0,948, respectivamente). Los gráficos de Bland-Altman reflejaban valores inferiores de FGe para la ecuación CKD-EPI. En el estadio 2, el 21,2% eran reasignados por CKD-EPI al estadio 3, siendo las mujeres mayores de 83 años el subgrupo más desfavorecido, con el 27,3% de reclasificación. Conclusiones: La CKD-EPI aplicada al cálculo del FGe en PP empeora los resultados de la estimación mediante MDRD-4. Origina, de forma general, valores de FGe inferiores e incrementa el grado de insuficiencia renal, en especial en mujeres más añosas (AU)

Background and objective: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version Patients and method: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1: > 90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m2. We analyzed the correlation between both and the patients reclassified by CKD-EPI. Results: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m2 by MDRD-4 and 52.7 (23.0) ml/min/1.73m2 by CKD-EPI (P < .001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. Conclusion: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women (AU)

[Diagnostic ability of Chronic Kidney Disease Epidemiology Collaboration and Modification of Diet in Renal Disease-4 equations to estimate glomerular filtration rate in with multimorbidity patients]. / Capacidad diagnóstica de las ecuaciones Chronic Kidney Disease Epidemiology Collaboration y Modification of Diet in Renal Disease-4 en la estimación del filtrado glomerular en pacientes pluripatológicos.

BACKGROUND AND OBJECTIVE: The Modification of Diet in Renal Disease (MDRD) equation is recommended by most scientific societies to calculate the estimated glomerular filtration rate (GFR). Recently the group Chronic Kidney Disease Epidemiology Collaboration (CKP-EPI) has published a new, more precise and accurate equation. We have analyzed its behavior in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version PATIENTS AND METHOD: Multicenter, observational, descriptive and transversal study. We calculated GFR by MDRD-4 and CKD-EPI in 425 PP. Each stage was assigned according to the GFR: 1:>90; 2: 60-89; 3: 30-59; 4: 15-29; and 5 < 15 ml/min/1.73m(2). We analyzed the correlation between both and the patients reclassified by CKD-EPI. RESULTS: Mean age was (mean [SD]) 81.7 (7.9) years. 55.3% were women. The mean estimated GFR was 58.6 (26.3) ml/min/1,73m(2) by MDRD-4 and 52.7 (23.0) ml/min/1.73m(2) by CKD-EPI (P<.001; Spearman's Rho correlation and Lin concordance coefficients: 0.993 and 0.948). The Bland-Altman plots reflected lower values for GFR for CKD-EPI equation. In the stage 2, 21.2% were reclassified by CKD-EPI to the stage 3, with women older than 83 years being the more disadvantaged subgroup with 27.3% or reclassification. CONCLUSION: CKD-EPI equation applied to PP worsens the results of MDRD-4. In general, it originates low values of GFR and increases the degree of renal insufficiency, especially in older women.

Differential characteristics in polypathological inpatients in internal medicine departments and acute geriatric units: the PLUPAR study.

AIM: To determine whether there are any differences between polypathological patients attended in Internal Medicine departments and acute Geriatric units. METHODS: A cross-sectional multicenter study was performed. Polypathological patients admitted to an internal medicine or geriatrics department and attended by investigators consecutively between March 1 and June 30, 2011 were included. Data of age, sex, living in a nursing residence or at home, diagnostic category, use of chronic medication, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, delirium during last admission, need of a caregiver, and having a caregiver were gathered. The need of a caregiver was defined when the Barthel index was<60 or Pfeiffer questionnaire ≥ 3 errors. RESULTS: 471 polypathological patients, 337 from internal medicine and 144 from geriatrics units were included. Geriatrics inpatients were older and more frequently female. Cardiac (62.1% vs 49.6%; p=.01), digestive (8.3% vs 3.0%; p=.04) and oncohematological diseases (30.2% vs 18.8%; p=.01) were more frequent in patients of internal medicine units and neurological (66.2% vs 40.2%; p<.001) and locomotive ones (39.1% vs 20.4%; p<.001) in geriatrics inpatients. Charlson index was higher for internal medicine inpatients [4.0(2.1) vs 3.5(2.1); p=.04). Patients attended in geriatrics scored higher in Pfeiffer questionnaire [5.5(3.7) vs 3.8(3.3); p<.001], and lower in Barthel [38.8(32.5) vs 61.2(34.3); p=.001] and Lawton-Brody indexes [0.9(1.6) vs 3.0(2.9); p<.001], and more frequently needed a caregiver (87.8% vs 53.6%; p<.001) and had it. CONCLUSIONS: There are differences in disease profile and functional and cognitive situation between polypathological patients of internal medicine and geriatrics departments.