Multidimensional prognostic index in a cognitive impairment outpatient setting: mortality and hospitalizations. The Treviso Dementia (TREDEM) study.

BACKGROUND: The Multidimensional Prognostic Index (MPI) based on a comprehensive geriatric assessment has been developed to predict mortality in hospitalized elderly patients. The Treviso Dementia (TREDEM) Study is an observational prospective cohort study of 1,364 outpatients evaluated at the Cognitive Impairment Center in Treviso, Italy from 2000 to January 2010. OBJECTIVE: To use the MPI in the TREDEM outpatient setting to assess the correlation of MPI with mortality and hospitalizations for acute cases that occurred after the date of assessment. METHODS: MPI was consecutively applied to the last 340 of 1,364 outpatients who were evaluated at the Center from 2008 to January 2010, after the first publication of MPI index in 2008. Participants' mortality was verified by linking the cohort with Registries of Municipalities, National Register of Revenue Authorities, and Nominal Register of Causes of Death. Data about hospitalizations for acute cases that occurred within 12 months after the date of assessment were obtained from all Italian hospitals. A Cox regression method was used to investigate the effect of MPI upon mortality and hospitalizations, also considering confounder factors such as age and gender. RESULTS: 114 men and 226 women, aged 52.1-99 years (mean age 80.4 years), were studied and had an MPI mean of 0.41. On 15 February 2013, 100 were deceased, and average hospitalizations for acute cases were 0.3, days 3.8. For MPI scores between 0 and 1, the increase in the probability of death was more than nine times (odds: 9.53 p = 0.0002) and of hospitalization was more than six times (odds: 6.50, p = 0.0079). CONCLUSION: MPI discloses the risk of death and of hospitalizations for acute cases in outpatients affected by cognitive impairment.

Peritoneal ultrafiltration in refractory heart failure: a cohort study.

INTRODUCTION: Acutely decompensated heart failure (HF) in patients with diuretic resistance is often treated with extracorporeal ultrafiltration. Peritoneal ultrafiltration (PUF) has been proposed for the long-term management of severe HF after resolution of the acute episode. The aim of the present study was to evaluate the use of PUF in the treatment of chronic refractory HF in patients without end-stage renal disease. ♢ METHODS: This multicenter (10 nephrology departments throughout Italy) retrospective observational study included patients with severe HF refractory to maximized drug treatment. The patients were proposed for PUF because they had experienced at least 3 hospital admissions in the preceding year for acutely decompensated HF requiring extracorporeal ultrafiltration. ♢ RESULTS: Of the 48 study patients (39 men, 9 women; mean age 74 ± 9 years), 30 received 1 nocturnal icodextrin exchange, 5 required 2 daily exchanges, and 13 received 2 - 4 sessions per week of automated peritoneal dialysis. During the first year, renal function remained stable (initial: 20.8 ± 10.0 mL/min/1.73 m(2); end: 22.0 ± 13.6 mL/min/1.73 m(2)), while pulmonary artery systolic pressure declined to 40 ± 6.09 mmHg from 45.5 ± 9.18 mmHg (p = 0.03), with a significant concomitant improvement in New York Heart Association functional status. Hospitalizations decreased to 11 ± 17 days/patient-year from 43 ± 33 days/patient-year before the start of PUF (p < 0.001). The incidence of peritonitis was 1 episode in 45 patient-months. Patient survival was 85% at 1 year and 56% at 2 years. ♢ CONCLUSIONS: This study confirms the satisfactory results of using PUF for chronic HF in elderly patients.

[Comparison of renal ultrasonographic and functional biometry in healthy patients and in patients with chronic renal failure]. / Confronto tra biometria ecografica e funzionale renale in pazienti sani e in pazienti con IRC.

OBJECTIVE: The purpose of this study, that examined healthy adult subjects and nephropatic patients, was to detect some relations between kidney's sonographic dimensions and renal function, expressed by creatinine clearance to evaluate more significant and useful sonographic parameters for the follow-up of nephropathies. SUBJECTS AND METHODS: Age, sex, body weight, height, body mass index, creatinine clearance were evaluated in 15 healthy and in 32 nephropathic subjects. In those subjects length, width, and thickness of the kidney and its central echogenic area and the parenchimal thickness of the upper pole were measured by ultrasonographic technique. Measurements were made with the patients in supine/oblique position. Renal shape index, parenchimal volume of the kidney and volume of the central echogenic area were calculated. Renal dimensions were correlated with age, total body area, body mass index and creatinine clearance. The patients, according to creatinine clearance, were divided into three classes: Class 1 Creatinine Clearance > 70 ml/min Class 2 Creatinine Clearance > 30 < 70 ml/min Class 3 Creatinine Clearance < 30 > 10 ml/min RESULTS: The renal length, as renal failure progressed significantly decreased until creatinine clearance = 30 ml/min. In class 3 the renal volume and the transvers diameter decreased as renal failure progressed. The renal parenchymal volume as renal failure progressed significantly decreased. Our results demonstrated that renal length reduced inside the three classes of patients but the reduction was significant only between the first and the second classes of patients. The transverse diameter and the renal shape index did not reduce significantly inside three classes of patients. The renal parenchimal volume reduced significantly inside the 3 classes. CONCLUSIONS: The more important measurement of renal size is longitudinal diameter in subjects with normal renal function. However, the renal parenchimal volume is the more exact sonographic parameter in end-stage renal failure.