Polypathological Patients Research Articles

Estratificación pronóstica y abordaje asistencial de los pacientes pluripatológicos

Polypathological patients constitute a prevalent, fairly homogeneous population, which is characterised by high clinical complexity, substantial vulnerability and significant resource consumption, in addition to high mortality and the need for comprehensive, coordinated care. It is particularly important to establish a reliable prognosis in these patients. It is also extremely useful for professionals involved in the decision-making process for patients and their families in vital planning and their preferences, for strategic health planning in management fields, and for clinical research, by facilitating their incorporation into clinical trials and other intervention studies. Two prognostic instruments stand out in terms of suitability for polypathological patients: PROFUND and PROFUNCTION. The former faithfully stratifies the risk of dying at 12 months and four years and the latter, the risk of suffering a significant functional deterioration at 12 months. In terms of the healthcare approach in patients with multiple pathologies, creating and executing a consensual, personalised action plan that is adapted to the patient's reality is encouraged. The plan will consider the prognosis, and the evidence and viability of interventions; its ultimate aim will be to ensure the synergy and alignment of the health team's goals and strategies with peoples’ values and preferences, in order to achieve a more proactive health model focused on supporting patients in their ability to manage their illnesses. In the personalised action plan, the main areas of intervention are: health promotion and prevention; patient and caregiver activation and self-management; activation of a social support network and social support; optimisation of pharmacotherapy; rehabilitation, functional and cognitive preservation measures; and anticipated decision planning.

La pluripatología, un fenómeno emergente y un reto para los sistemas sanitarios

Improvements in living conditions and scientific advances have led to an unprecedented demographic change. The curing of numerous acute diseases and the growing adoption of unhealthy lifestyles have caused a pandemic of cumulative chronic diseases that constitute the leading cause of death worldwide. Currently, the most common situation is the coexistence of multiple chronic diseases (or polypathology). This situation undermines socio-economic development and increases inequality. This results in an overriding need to change the way in which health and disease are addressed. Healthcare systems are not prepared to meet the needs of complex polypathological patients. In this article, we summarise the challenges facing healthcare systems and states, as well as the main recommendations from the organisations responsible for healthcare.

Pluripatología, polifarmacia, complejidad terapéutica y uso adecuado de la medicación

Polypathological patients are usually elderly and take numerous drugs. Polypharmacy affects 85% of these individuals and is not associated with greater survival. On the contrary, polypharmacy exposes these individuals to more adverse effects, such as weight loss, falls, functional and cognitive impairment and hospitalisations. The complexity of a drug regimen covers more aspects than the simple number of drugs consumed. The galenic form, the dosage and the method for preparing the drug can impede the understanding of and compliance with prescriptions. Both polypharmacy and therapeutic complexity are associated with poorer adherence by patients. To prevent polypharmacy, reduce complexity and improve adherence, the appropriate use of drugs is needed. Proper prescribing consists of selecting drugs that have clear evidence for their use in the indication, which are appropriate for the patient's circumstances, are well tolerated and cost-effective and whose benefits outweigh the risks. To improve the drug prescription, periodic reviews of the drugs need to be conducted, especially when the patient changes doctor and during healthcare transitions. The Beers and STOPP/START (Screening Tool of Older Person's potentially inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) criteria are effective tools for this improvement. Deprescription for polymedicated polypathological patients that considers their clinical circumstances, prognosis and preferences can contribute to a more appropriate use of drugs.

Internal medicine network: a new way of thinking hospital-territory integration and public-private partnership

This working proposal aims to establish an Internal Medicine Network (IMN) model for the appropriate management or the poly-pathological complex patient in the different phases of illness natural history. The IMN is based on an organization recalling the Hub and Spoke system already used for existing specialized networks. The Internal Medicine Unit (IMU) is the natural destination of acutely ill patients suffering from systemic or multi-organ diseases. Three are the IMU specific tasks: 1. To stabilize acute, severe, poly-pathologic and complex patients; 2. To develop difficult etiological diagnosis in these patients and in those who should necessarily be admitted to the hospital, not being possible, for different reasons, alternative routes; 3. To select the acute poly-pathologic complex patient's priorities. The expected results of a new model of integration system inside the IMN are: A) reduction and rationalization of expenditure in the medical area, increasing effectiveness, quality and safety guaranteeing patient centrality, B) patients stratification based on characteristics of gravity, acute illness, estimated duration of hospitalization, C) reduction of inappropriate hospital admissions ensuring connections between hospital and primary care units; D) definition of different care pathways for patients hospitalized for Non Communicable Diseases (NCD); E) implementation of new common medical records. The public-private partnership inside the IMN could be able to increase appropriateness reducing health costs. Patient cantered problems assessment, together with integration, cooperation, coordination and effective communication are some simple rules useful to achieve tangible results in a complex system and the IMN model represents its practical application.

CRONIGAL: Prognostic index for chronic patients after hospital admission

ObjectiveWe have followed patients admitted to a Polypathology and Advanced Age Unit for two years in order to identify the variables that best define the mortality prognosis at medium-term (1–2years) for chronic and polypathological patients requiring admission at an Internal Medicine Department. MethodsThis is an observational, prospective study in clinical practice. Polypathological, chronic or multimorbidity patients were included. The classification of the Spanish Ministry for Health was used in order to classify patients as chronic or polypathological. The Charlson Index and Barthel Index were estimated and the Pfeiffer test was administered. The Spanish PROFUND Index was also used. Logistic regression models and Cox proportional hazard model were built in order to study the influence of prognostic factors on survival. ResultsA total of 567 patients were included: 333 met polypathological (PPP) criteria and 234 chronic criteria (CC). Mean age was 84.8+7.3years. A total of 469 were followed up, most patients belonged to category E (282), 174 to category A and 118 to category C. The prognosis at one year of our patients can be estimated with 7 variables: age, neoplasia, delirium, Barthel, Pfeiffer, presence of atrial fibrillation, and creatinine. The area under the curve is 0.74. ConclusionThe variables dementia, neoplasia, delirium at admission, Barthel Index under 60, or deceased spouse have mortality prognosis value at one or two years. An index with 7 variables applicable to chronic and polypathological patients after admission may serve as tool to better manage complex chronic patients and follow them up.

Reliability of the PROFUND index to predict 4-year mortality in polypathological patients

ObjectiveTo determine the usefulness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Patients and methodsMulticentre prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton–Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, haemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. ResultsWe included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and ≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689–0.806, p<0.001 in Internal Medicine and 0.517, 95% CI 0.369–0.666, p=0.818 in Geriatrics patients, respectively. ConclusionsThe PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments.

Validation of PROFUND prognostic index over a four-year follow-up period

Background/objectivesThe PROFUND index stratifies accurately the 12-month mortality risk of polypathological patients (PPs), but its fitness over a longer follow-up period remains unknown. We aimed to explore the calibration and discrimination power of PROFUND index over 4-years, in order to assess its follow-up interval generalizability. DesignMulticenter prospective cohort-study. Setting33 Spanish hospitals. ParticipantsPPs included after hospital discharge, outpatient clinics, or home hospitalization. MeasurementsMortality over a 4-year follow-up period. MethodsPROFUND index calibration was assessed by risk-quartiles predicted/observed mortality (Hosmer–Lemeshow goodness-of-fit test), and its discrimination power by ROC curves. ResultsA total of 768 patients were included (630 [82%] of them completed the 4-year follow-up). Global mortality rate was 63.5%. When assessing individual patient scores, mortality was 52% in the lowest risk group (0–2 points in PROFUND score); 73.5% in the low-intermediate risk group (3–6 points), 85% in the intermediate-high group (7–10 points); and 92% in the highest risk group (≥11 points). Accuracy testing of the PROFUND index showed good calibration (P=.8 in the Hosmer–Lemeshow goodness-of-fit test), and also a good discrimination power (AUC=0.71 [0.67–0.77] in ROC curve). ConclusionsThe PROFUND index maintained its accuracy in predicting mortality of polypathological patients over a 4-year follow-up period. This index may be of potential usefulness in deciding the most appropriate health-care interventions in populations with multimorbidity.

Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada

ObjectiveTo analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP). MethodMulticentre observational, prospective study of 672 patients aged 75 years and older hospitalised in Internal Medicine between April 2011 and March 2012. The Beers, STOPP-START and ACOVE criteria were used to detect potentially inappropriate prescribing and the results of PP and non-PP patients were compared. ResultsOf the 672 patients included, 419 (62%) were polypathological, of which 89.3% met PIP criteria versus 79.4% of non-polypathological patients (p <0.01). 40.3% of polypathological patients met at least one Beers criteria, 62.8% at least one STOPP criteria, 62.3% at least one START criteria and 65.6% at least one ACOVE criteria. The rate of potentially inappropriate prescribing was higher in polypathological patients regardless of the tool used. ConclusionsGiven the high rate of potentially inappropriate prescribing in polypathological patients, strategies to improve prescribing adequacy must be developed.

Utilidad del índice PROFUND para predecir la mortalidad a los 4 años en pacientes pluripatológicos

ObjectiveTo determine the usefullness of the PROFUND index to assess the risk of global death after 4 years in polypathological patients. Patients and methodsMulticenter prospective cohort (Internal Medicine and Geriatrics) study. Polypathological patients admitted between March 1st and June 30th 2011 were included. For each patient, data concerning age, sex, living at home or in a nursing residence, polypathology categories, Charlson, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs, hemoglobin and creatinine values were gathered, and the PROFUND index was calculated. The follow-up lasted 4 years. ResultsWe included 441 patients, 324 from Internal Medicine and 117 from Geriatrics, with a mean age of 80.9 (8.7) years. Of them, 245 (55.6%) were women. Heart (62.7%), neurological (41.4%) and respiratory (37.3%) diseases were the most frequent. Geriatrics inpatients were older and more dependants and presented greater cognitive deterioration. After 4 years, 335 (76%) patients died. Mortality was associated with age, dyspnoea, Barthel index<60, delirium, advanced neoplasia and≥4 admissions in the last year. The area under the curve of the PROFUND index was 0.748, 95% CI 0.689-0.806, P<.001 in Internal Medicine and 0.517, 95% CI 0.369-0.666, P=.818 in Geriatrics patients, respectively. ConclusionsThe PROFUND index is a reliable tool for predicting long-term global mortality in polypathological patients from Internal Medicine but not from Geriatrics departments.

A model to improve the appropriateness in the management of acute poly-pathological patients: the acute complex care model

Improved care for acute diseases has increased mean age and the proportion of people affected by multiple chronic diseases, while mutated socioeconomic conditions augmented the number of elderly and socially frail subjects. Multi-morbid patients who require a global approach not fragmented care interventions and a close connection between health and social services are progressively growing. Acute complex care model (ACCM) is a model of integrated management of the frail patients when they need of acute hospital care. The name of our model - ACCM - just recalls the Chronic Care Model (CCM), designed for the dehospitalization of chronic patients by preventing acute exacerbations, representing the hospital counterpart of the CCM. The target population are acutely ill complex and polypathological patients (AICPPs), admitted to hospital and requiring high technological resources and continuous monitoring; the mission is improving the management of medical admissions through pre-defined intra-hospital tracks and a global, multidisciplinary, patientcentred approach. Nowadays, multiple uncoordinated specialists care for AICPPs who move from one ward to another, with dangerous loss of information and continuity. ACCM tries to overcome these problems by putting the internal medicine specialist as the only referent for that patient and the coordinator of the care team. According to a model of future hospital organized with different intensity settings, the Internal Medicine Wards (IMWs), caring for AICPPS, are organized in High Dependency Areas and Ordinary Areas. For both we present organizational and personnel standards that are lacking in daily practice. The epidemiological transition leading to a progressive increase in AICPPs requiring frequent hospitalization enhances the role of hospital internal medicine specialist in the coordination and delivery of care. The ACCM represents a practical response to this epochal change of roles. Medical and nursing staff standards and competencies has to be reviewed to ensure adequate care for these patients.

Internal Medicine and emergency admissions: from a national Hospital Discharge Records (SDO) study to a regional analysis

In Italy, the number of Internists has grown by 10% since 1990 reaching 11,435 units, they manage 39,000 beds in 1060 Internal Medicine (IM) wards. The Internists are expected to ensure a cost-effective management of poly-pathological and complex patients. A collaborative study between FADOI and CREA Sanità based on data from hospital discharge records (SDO) starting from November 2014. In this article are shown the preliminary results with focus on emergency admissions characteristics to contribute to define the role of hospital Internal Medicine. Evaluation is performed comparing emergency and planned admissions, IM impact on hospital admissions, availability of community-based healthcare services, DRGs (Diagnosis Related Groups) weight in IM and regional differences in managing hospital admissions with focus on IM department. In 2013 IM wards discharged 1.073.526 patients, (16.18% of the total discharged by hospitals) with a total economic value of 3.426.279.881 € (average DRG 3882,80 €, from 3,682,19 to 4.083,42). The average length of stay (LOS) in IM was 9.3 days. IM covers 27% of admissions from Emergency Room (ER). Determinants significantly affecting the emergency admissions are old age and comorbidities of the patients that also have a role in increasing LOS. 55% of Italian hospital admissions are emergency admissions. Hospitalization rates in emergency are systematically higher than those in election and the greatest differences are in the regions with inefficiently organized regional network. The role of the hospital Internal Medicine appears central in the offer of beds to the emergency room by accepting 27% of urgent admissions. The increasing impact of Internal Medicine on hospital management will put the internists as authoritative stakeholders in health policy.

Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life.

In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

External validation of the PROFUND index in polypathological patients from internal medicine and acute geriatrics departments in Aragón.

The objective of the study was to validate externally and prospectively the PROFUND index to predict survival of polypathological patients after a year. An observational, prospective and 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 concerning age, gender, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer questionnaire, socio-familial Gijon scale, delirium, number of drugs and number of admissions during the previous year were gathered for each patient. The PROFUND index was calculated. The follow-up lasted 1 year. A Cox proportional regression model was calculated, and was used to analyze the association of the variables to mortality and C-statistic. 465 polypathological patients, 333 from internal medicine and 132 from geriatrics, were included. One-year mortality is associated with age [hazard ratio (HR) 1.52 95 % CI 1.04-2.12; p = 0.01], presence of neoplasia [HR 2.68 95 % CI 1.71-4.18; p = 0.0001] and dependence for basic activities of daily living [HR 2.34 95 % CI 1.61-3.40; p = 0.0009]. In predicting mortality, the PROFUND index shows good discrimination in patients from internal medicine (C-statistics 0.725 95 % CI 0.670-0.781), but a poor one in those from geriatrics (0.546 95 % CI 0.448-0.644). The PROFUND index is a reliable tool for predicting mortality in internal medicine PP patients.

Excessive polypharmacy and survival in polypathological patients.

The purpose of this study was to determine whether excessive polypharmacy is associated with a higher survival rate in polypathological patients. An observational, prospective, and multicenter study was carried out on those polypathological patients admitted to the internal medicine and acute geriatrics departments between March 1 and June 30, 2011. For each patient, data concerning age, sex, comorbidity, Barthel and Lawton-Brody indexes, Pfeiffer's questionnaire, socio-familial Gijon scale, delirium, number of drugs, and number of admissions during the previous year were gathered, and the PROFUND index was calculated. Polypharmacy was defined as the use of ≥ 5 drugs and excessive polypharmacy as the use of ≥ 10. A 1-year long follow-up was carried out. A logistic regression model was performed to analyze the association of variables with excessive polypharmacy and a Cox proportional hazard model to determine the association between polypharmacy and survival. We included 457 polypathological patients. Mean age was 81.0 (8.8) years and 54.5% were women. The mean number of drugs used was 8.2 (3.4). Excessive polypharmacy was directly associated with heart disease [hazard ratio (HR) 2.33 95% CI 1.40-3.87; p =0.001], respiratory disease [HR 1.87 95% CI 1.13-3.09; p = 0.01], peripheral artery disease/diabetes with retinopathy and/or neuropathy [HR 2.02 95% CI 1.17-3.50; p = 0.01], and the number of admissions during the previous year [HR 1.21 96%CI 1.01-1.44; p = 0.04]. It was inversely associated with delirium [HR 0.48 95% CI 0.25-0.91; p = 0.02]. There were no statistical differences regarding the probability of 1-year survival between patients with no polypharmacy, with simple polypharmacy, and with excessive polypharmacy (0.66, 0.60, and 0.57, respectively, p = 0.12). A greater use of drugs may not be harmful but is also not associated with a higher probability of survival in polypathological patients.

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

Background and objectiveThe 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 analysed its behaviour in a group of polypathological patients (PP) and compared it with the classic MDRD-4.version. Patients and methodMulticenter, 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 <15ml/min/1.73m2. We analysed the correlation between both and the patients reclassified by CKD-EPI. ResultsMean 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. ConclusionCKD-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.

P531: An observational multicenter study in Turkey to evaluate beta-hydroxy-beta methyl butyrate, L-arginine and L-glutamine usage patterns in daily practice: sarcopenia in elderly

Results: There were 300 patients aged over 65, the mean age was 76.48±7 years [65–94 years]. 49% of patients were aged 75 years and older. Our series included 162 men (54%) and 138 women (46%), polypathological patients (17%), polymedicated patients (25%). As past medical history, there was: heart disease (47.5%), diabetes (21.3%), neoplasia (8.7%), gastric ulcers (7.8%), stroke (7.8%) and hepathopathy (0.4%). In biology, we noted: anemia (50.7%), hypoalbuminemia (55.7%). The mean dose of Sintrom used was 2.6±0.9G/d. The mean duration of AVKs treatment was 7.6 months. AVK overdose was noted in 34% of cases (7% showed hemorrhagic complication). The Warfarin INR was within the therapeutic range in 56%. Contributing factors were: combination therapy (6 cases), bad observance (3 cases), infectious syndrome (1 case), and disorders of blood crass (2 cases). In 85% of cases the overdose had occurred at the waning of the first three months of treatment. Conclusion: The frequency of thromboembolic diseases and their severity and the benefit of anticoagulation, requires an individual and periodic evaluation of the risk/benefit ratio.

Validación de un modelo pronóstico para pacientes pluripatológicos en atención primaria: Estudio PROFUND en atención primaria

Aimsto validate the PROFUND index in PP in Primary Health Care (PHC). Designtwo-year prospective multicenter study. Locationthree health care centers in Seville Province (Spain). Subjects of the assessmentPP with signed informed consent. Sample: n=446 (p=20%; α=5%; β=99%); consecutive sampling. MeasurementDependent variable: mortality (2 years). Independent variables: socio-demography, clinic, anthropometric, laboratory, pharmacologic prescriptions, functional, cognitive and socio-familiar evaluation and the use of health resources. Information sourceinterview with patients and clinical charts. Statistical Analysisuni and multivariate analysis according to the variables; Accuracy was assessed in the cohort by risk terciles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index. Results446 subjects were included (53.8% men); average age was 75.44yr (Confidence interval 95% 74.58–76.31). Average of diagnostic categories was 2.37 (Confidence interval 95% 2.30–2.44). Prevalent categories were: A (64.1%), F (41.7%) and E (33.5%). Mortality within 2 years was 24.1%. Calibration in predicted/observed mortality along the three established risk strata was 16%/16.7% for PP with 0–2 points, 22%/19.5% for PP with 3–6, and 34%/36% for PP with 7 or more points (Hosmer-Lemeshow test with p=0.119). Discrimination power of PHC PROFUND's by area under the curve was (AUC) ROC was 0.622 (Confidence interval 95% 0.556–0.689; p<0.001), and that of Charlson index 0.510 (Confidence interval 95% 0.446 - 0.575; p>0.005). ConclusionsThe PROFUND index is a good indicative tool in the stratification of 2-year mortality risk polypathological patients in PHC.

CP-032 Prevalence of comorbidities and effect on ART adherence in HIV-infected patients

BackgroundAs people with HIV infections age, comorbidities and complications have increased and could affect antiretroviral therapy (ART) adherence.PurposeTo determine the comorbidities of patients with HIV infection, as well as to...

DI-040 Risk of assessment bias of systematic reviews that study interventions to improve medicines adherence in polypathological patients

BackgroundThe quality of studies assessing the effectiveness of interventions aimed at improving adherence in patients with multiple chronic conditions is variable so it is difficult to know if they reach...

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 objectiveThe 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 methodMulticenter, 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<15ml/min/1.73m2. We analyzed the correlation between both and the patients reclassified by CKD-EPI. ResultsMean 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. ConclusionCKD-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.