3700 The goal trial—comprehensive geriatric assessment for frail older people living with chronic kidney disease

Abstract Background Frail older people living with chronic kidney disease (CKD) have complex care needs and are at increased risk of adverse outcomes. Comprehensive geriatric assessment (CGA) benefits older people, but its effectiveness in allowing this population to attain their goals is unknown. GOAL investigates this. Methods This cluster randomised controlled trial recruited participants (Frailty Index [FI] >0.25; aged ≥65 years, or ≥ 55 years for First Nations people; CKD stage 3–5/5D [eGFR<59 mL/min/1.73 m2]) from kidney outpatient clinics. Clinics were randomised 1:1 to CGA plus usual care (intervention) or usual care alone (control). The primary outcome was Goal Attainment Scaling (GAS) at 3 months. Secondary outcomes included GAS up to 12 months, quality of life (EQ-5D-5L), FI, mortality, hospitalisations and residential aged care admissions. Intention-to-treat analysis was conducted at the cluster- and participant-level. Exploratory analyses investigated effects of intercurrent events. Results 240 participants (mean age 76.9 ± 6.6 years, median FI 0.39 [IQR 0.33–0.47]), 114 at 7 intervention clusters and 126 at 8 control clusters. Retention was challenging during COVID, with 22 (19%) not receiving their planned CGA. At 3-month follow-up, mean GAS scores were not significantly different between the intervention and control groups (45.2 ± 11.7 vs 43.7 ± 10.9, respectively, p = 0.47). There were also no significant differences observed in the secondary outcomes. No serious adverse events were reported. Conclusion In frail older people living with CKD, CGA administered in outpatients did not improve their ability to attain their goals. Geriatricians should continue to manage this population’s geriatric syndromes like falls, dementia and delirium.