COMPREHENSIVE GERIATRIC ASSESSMENT FOR FRAIL OLDER PEOPLE LIVING WITH CHRONIC KIDNEY DISEASE – A CLUSTER RANDOMIZED CONTROLLED TRIAL (THE GOAL TRIAL)

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Abstract Title *

COMPREHENSIVE GERIATRIC ASSESSMENT FOR FRAIL OLDER PEOPLE LIVING WITH CHRONIC KIDNEY DISEASE – A CLUSTER RANDOMIZED CONTROLLED TRIAL (THE GOAL TRIAL)

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Co-author 1

Benignus Logan benignus.logan@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia *

Co-author 2

Andrea K Viecelli andrea.viecelli@hin.ch University of Queensland Centre of Health Services Research Brisbane Australia *

Co-author 3

David W Johnson david.johnson2@health.qld.gov.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 4

Carmel M Hawley c.hawley@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 5

Laura E Hickey laura.hickey@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 6

Charani Kiriwandeniya c.kiriwandeniya@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 7

Misa Matsuyama m.matsuyama@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 8

Gabor Mihala g.mihala@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 9

Elaine M Pascoe e.pascoe@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 10

Peta-Anne Paul-Brent p.kerr@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 11

Donna Reidlinger d.reidlinger@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 12

Nicole Scholes-Robertson nicole.scholes-robertson@sydney.edu.au University of Sydney School of Public Health Sydney Australia -

Co-author 13

Andrea Valks a.valks1@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 14

Ruth E Hubbard r.hubbard1@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Co-author 15

on behalf of The GOAL Trial Investigators goal@uq.edu.au University of Queensland Centre of Health Services Research Brisbane Australia -

Introduction

Comprehensive geriatric assessment (CGA) benefits older people but has not been evaluated in chronic kidney disease (CKD). Frail older people with CKD have complex care needs. The GOAL trial examined whether CGA helped this population attain their goals.

Methods

In this cluster randomized controlled trial, kidney outpatient centers were assigned (1:1) to provide CGA plus usual care or usual care alone for frail older people with CKD (Frailty Index [FI] >0.25; aged ≥65 years, or ≥55 years for First Nations people; CKD stage 3–5/5D [eGFR≤59mL/min/1.73m2]). The primary outcome was Goal Attainment Scaling (GAS) at 3 months, analyzed using mixed-effects linear regression. Secondary outcomes were quality of life, FI, mortality, hospitalizations, and residential aged care admissions. Analyses were intention-to-treat at cluster and participant levels.

Results

A total of 240 participants were recruited (mean age 76.9 years [SD 6.6]; median FI 0.39 [IQR 0.33–0.47]); 114 were from 7 intervention clusters and 126 from 8 control clusters. Retention was challenging during COVID, with 19% (22/114) not receiving CGA within 14 days. At 3 months, GAS scores did not differ significantly between intervention and control groups (45.2 [SD 11.7] vs 43.7 [SD 10.9]; mean difference 1.54, 95% CI -3.13–6.20; p=0.47). No significant differences were observed in secondary outcomes. An average 2.5-day reduction in hospital stay over 12 months was noted in the intervention group (p=0.54).

Conclusion

In frail older people with CKD, outpatient CGA did not improve individualized goal attainment.

Kewords