Baseline Characteristics of Frailty and Disease Stage in Older People Living With CKD

Benignus Logan; Elaine M Pascoe; Andrea K Viecelli; David W Johnson; Tracy Comans; Carmel M Hawley; Laura E Hickey; Monika Janda; Allison Jaure; Emarene Kalaw; Charani Kiriwandeniya; Misa Matsuyama; Gabor Mihala; Kim-Huong Nguyen; Jason D Pole; Kevan R Polkinghorne; Dimity Pond; Rajesh Raj; Donna M Reidlinger; Nicole Scholes-Robertson; Andrea Valks; Germaine Wong; Ruth E Hubbard; GOAL Trial Investigators

doi:10.1016/j.ekir.2024.10.009

Baseline Characteristics of Frailty and Disease Stage in Older People Living With CKD

Kidney Int Rep. 2024 Oct 15;10(1):120-133. doi: 10.1016/j.ekir.2024.10.009. eCollection 2025 Jan.

Authors

Benignus Logan^{1

2}, Elaine M Pascoe², Andrea K Viecelli^{3

4}, David W Johnson^{3

4

5}, Tracy Comans^{1

2

6}, Carmel M Hawley^{3

4}, Laura E Hickey³, Monika Janda², Allison Jaure⁷, Emarene Kalaw³, Charani Kiriwandeniya³, Misa Matsuyama³, Gabor Mihala^{2

3}, Kim-Huong Nguyen^{2

8

9}, Jason D Pole^{2

10}, Kevan R Polkinghorne^{11

12

13}, Dimity Pond^{14

15}, Rajesh Raj^{16

17}, Donna M Reidlinger^{1

2}, Nicole Scholes-Robertson^{7

18}, Andrea Valks³, Germaine Wong^{7

18

19}, Ruth E Hubbard^{1

2

20}; GOAL Trial Investigators

Collaborators

GOAL Trial Investigators:
Deanna Nisha Antony, Ricky Arenson, Owen Bale, Sabine Braat, Benilda Maria Lobo Brites, Sally Broers, Graham Buckle, Sreenath Bukkapatnam, Joanne Cerni, Doris Chan, Michael G Collins, Amanda Elms, John Fanning, Karen Fischer, Adam Flavell, Leon Flicker, Chloe Furst, Emily H Gordon, Sridevi Govindarajulu, Natalie Grainer, Stella Jean Green, Suetonia C Green, Chandana Guha, Samantha Hand, Leny Dwi Nur Hidayati, Rachael Irvine, Ibrahim Ismail, Shilpanjali Jesudason, George Kan, Ya-Yu Kang, Leonie Kelly, Debbie Kennedy, Khadija Khatry, Vinod Khelgi, Shannon Kokoszka, Anoushka Krishnan, Heather Lane, Diana Leary, Andrea Lees, Claire Long, Angela Makris, Khalilah Katherine Marquez, Amanda Maxwell, Amanda McGrath, David McIntyre, Penelope Murie, Karina Murphy, Danielle Ní Chróinín, Nancye M Peel, Stephanie Polley Xiaodan Qiu, Madeleine Rapisardi, Matthew A Roberts, Simon D Roger, Shailly Saxena, Shaundeep Sen, Edward Strivens, Julie Varghese, Louise M Waite, Robert Walker, Daniel Wong, Paul Andrew Yates, Belinda Yip, Andreea Zaharia

Affiliations

¹ Australian Frailty Network, The University of Queensland, Brisbane, Australia.
² Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
³ Australasian Kidney Trials Network, The University of Queensland, Brisbane, Australia.
⁴ Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia.
⁵ Centre for Kidney Disease Research, Translational Research Institute, Brisbane, Australia.
⁶ National Ageing Research Institute, Melbourne, Australia.
⁷ Sydney School of Public Health, The University of Sydney, Sydney, Australia.
⁸ School of Public Health, The University of Queensland, Brisbane, Australia.
⁹ Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland and University of California, San Francisco, California, USA.
¹⁰ Dalla Lana School of Public Health, The University of Toronto, Toronto, Ontario, Canada.
¹¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
¹² Department of Medicine, Monash University, Melbourne, Australia.
¹³ Department of Nephrology, Monash Health, Melbourne, Australia.
¹⁴ Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Australia.
¹⁵ University of New England, Armidale, Australia.
¹⁶ School of Medicine, University of Tasmania, Hobart, Australia.
¹⁷ Department of Nephrology, Launceston General Hospital, Launceston, Australia.
¹⁸ Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.
¹⁹ Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia.
²⁰ Department of General and Geriatric Medicine, Princess Alexandra Hospital, Brisbane, Australia.

Abstract

Introduction: The GOAL trial, a cluster randomized controlled trial, investigated the effect of comprehensive geriatric assessment (CGA) on frail older people with chronic kidney disease (CKD). This paper describes the following: (i) participant baseline characteristics, and (ii) their relationship with CKD stage and frailty severity.

Methods: Sixteen kidney outpatient clinics (clusters) were randomly allocated 1:1 to CGA or usual care. Enrolled frail older people with CKD (Frailty Index [FI] > 0.25; aged ≥65 years or ≥55 if First Nations people) received the intervention allocated to their cluster. CKD was defined as moderate (stages 3 or 4) or severe (stage 5 or 5D), and frailty categorized as moderate (>0.25-<0.36), severe (0.36-<0.45) or very severe (≥0.45). Participant characteristics were analyzed using descriptive statistics. Statistical methods appropriate for type of outcome were used to describe the association of frailty and CKD categories with participant characteristics.

Results: Over a 27-month period, 240 people were recruited (55.7% male, 82.9% White/European). Mean age was 76.9 (SD: 6.6) years and median FI was 0.39 (interquartile range [IQR]: 0.32-0.47). The median EQ-5D-5L quality-of-life index score was worse in those with very severe frailty (0.57, IQR: 0.28-0.83) compared to severe frailty (0.85, IQR: 0.67-0.92) and moderate frailty (0.90, IQR: 0.82-0.93) (overall P < 0.001). Median EQ-5D-5L was also worse in those with severe CKD (0.79, IQR: 0.40-0.89), compared to moderate CKD (median 0.87, IQR: 0.73-0.92; P = 0.001).

Conclusion: This cohort demonstrated poorer quality-of-life scores in those with more severe frailty and more advanced CKD.

Keywords: chronic kidney disease; comprehensive geriatric assessment; frailty; goal attainment scaling; older people; quality of life.