Randomized Controlled Trial of Individualized Intervention for Frailty Reversal in Older Patients With Nondialysis...

Frailty is highly prevalent among older adults with chronic kidney disease (CKD), yet evidence for targeted intervention remains limited. We evaluated whether a comprehensive geriatric assessment (CGA)-based individualized intervention could reverse frailty in this population.

In this randomized controlled trial conducted at Beijing Chao-yang Hospital, 242 frail patients with CKD (age ≥ 65, stage 3-5 nondialysis CKD, Fried score ≥ 3; excluding life expectancy < 1 year and communication difficulties) were allocated 1:1 to an intervention group receiving a 12-month individualized, CGA-based multidomain program encompassing tailored nutrition, psychological, and physical-function components or to a control group receiving routine care. The primary outcome was frailty reversion at 12 months (transition from Fried frailty score ≥ 3 to < 3), with secondary outcomes of unplanned hospitalization and all-cause mortality.

A total of 242 participants were enrolled (mean age 79.98 ± 7.52 years, 55.8% male, 74% had stage 3 CKD). At 12 months, frailty reversion was significantly higher in the intervention group than in the control group (30.6% vs. 7.4%, P < 0.001). Logistic regression confirmed that the CGA-based individualized intervention was independently associated with a higher likelihood of frailty reversion (age-adjusted odds ratio [OR] 5.22, 95% confidence intervals [CI]: 2.37-11.49). No significant differences were observed between groups in unplanned hospitalization or all-cause mortality.

CGA-based individualized intervention effectively and safely reversed frailty in older nondialysis patients with CKD, predominantly with stage 3 disease. However, no significant impact on unplanned hospitalization or mortality was observed. These findings may not be generalizable to patients with more advanced CKD.