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

Overview

Journal Kidney Int Rep

Publisher Elsevier

Date 2025 Jan 15

PMID 39810773

Authors

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

Affiliations

Soon will be listed here.

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 < 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; = 0.001).

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

References

Blodgett J, Theou O, Kirkland S, Andreou P, Rockwood K . Frailty in NHANES: Comparing the frailty index and phenotype. Arch Gerontol Geriatr. 2015; 60(3):464-70. DOI: 10.1016/j.archger.2015.01.016. View

Marten O, Brand L, Greiner W . Feasibility of the EQ-5D in the elderly population: a systematic review of the literature. Qual Life Res. 2021; 31(6):1621-1637. PMC: 9098572. DOI: 10.1007/s11136-021-03007-9. View

Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood R . Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2017; 9:CD006211. PMC: 6484374. DOI: 10.1002/14651858.CD006211.pub3. View

Clegg A, Bates C, Young J, Ryan R, Nichols L, Teale E . Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016; 45(3):353-60. PMC: 4846793. DOI: 10.1093/ageing/afw039. View

Turner G, Clegg A . Best practice guidelines for the management of frailty: a British Geriatrics Society, Age UK and Royal College of General Practitioners report. Age Ageing. 2014; 43(6):744-7. DOI: 10.1093/ageing/afu138. View

Mahmood U, Healy H, Kark A, Cameron A, Wang Z, Abeysekera R . Spectrum (characteristics) of patients with chronic kidney disease (CKD) with increasing age in a major metropolitan renal service. BMC Nephrol. 2017; 18(1):372. PMC: 5745771. DOI: 10.1186/s12882-017-0781-5. View

Inoue T, Shinjo T, Matsuoka M, Tamashiro M, Oba K, Arasaki O . The association between frailty and chronic kidney disease; cross-sectional analysis of the Nambu Cohort Study. Clin Exp Nephrol. 2021; 25(12):1311-1318. DOI: 10.1007/s10157-021-02110-y. View

Shariff A, Panlilio N, Kim A, Gupta A . Assessment of frailty and quality of life and their correlation in the haemodialysis population at Palmerston North Hospital, New Zealand. Nephrology (Carlton). 2023; 29(2):93-99. DOI: 10.1111/nep.14245. View

Chitalu P, Tsui A, Searle S, Davis D . Life-space, frailty, and health-related quality of life. BMC Geriatr. 2022; 22(1):646. PMC: 9356461. DOI: 10.1186/s12877-022-03355-2. View

10.

Blodgett J, Theou O, Howlett S, Wu F, Rockwood K . A frailty index based on laboratory deficits in community-dwelling men predicted their risk of adverse health outcomes. Age Ageing. 2016; 45(4):463-8. DOI: 10.1093/ageing/afw054. View

11.

Harris P, Taylor R, Thielke R, Payne J, Gonzalez N, Conde J . Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2008; 42(2):377-81. PMC: 2700030. DOI: 10.1016/j.jbi.2008.08.010. View

12.

Mitnitski A, Rockwood K . The rate of aging: the rate of deficit accumulation does not change over the adult life span. Biogerontology. 2015; 17(1):199-204. DOI: 10.1007/s10522-015-9583-y. View

13.

Kojima G, Iliffe S, Walters K . Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2017; 47(2):193-200. DOI: 10.1093/ageing/afx162. View

14.

Li B, Sang N, Zhang M, Liu Z, Fang R, Liu W . The prevalence and influencing factors of frailty in patients with chronic kidney disease: a systematic review and meta-analysis. Int Urol Nephrol. 2023; 56(2):767-779. DOI: 10.1007/s11255-023-03739-2. View

15.

Hubbard R, Peel N, Smith M, Dawson B, Lambat Z, Bak M . Feasibility and construct validity of a Frailty index for patients with chronic kidney disease. Australas J Ageing. 2015; 34(3):E9-12. DOI: 10.1111/ajag.12231. View

16.

Briggs R, McDonough A, Ellis G, Bennett K, ONeill D, Robinson D . Comprehensive Geriatric Assessment for community-dwelling, high-risk, frail, older people. Cochrane Database Syst Rev. 2022; 5:CD012705. PMC: 9074104. DOI: 10.1002/14651858.CD012705.pub2. View

17.

Rockwood K, Song X, MacKnight C, Bergman H, Hogan D, McDowell I . A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005; 173(5):489-95. PMC: 1188185. DOI: 10.1503/cmaj.050051. View

18.

Rockwood K, Howlett S, Stadnyk K, Carver D, Powell C, Stolee P . Responsiveness of goal attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin Epidemiol. 2003; 56(8):736-43. DOI: 10.1016/s0895-4356(03)00132-x. View

19.

Parker S, McCue P, Phelps K, McCleod A, Arora S, Nockels K . What is Comprehensive Geriatric Assessment (CGA)? An umbrella review. Age Ageing. 2017; 47(1):149-155. DOI: 10.1093/ageing/afx166. View

20.

Kennedy-Martin T, Curtis S, Faries D, Robinson S, Johnston J . A literature review on the representativeness of randomized controlled trial samples and implications for the external validity of trial results. Trials. 2015; 16:495. PMC: 4632358. DOI: 10.1186/s13063-015-1023-4. View