SynthesisBMC nephrology2026
Comprehensive geriatric assessment and optimisation in advanced chronic kidney disease: a systematic review and narrative synthesis examining clinical outcomes and decision-making.
Synthesis in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
1 citing paper in PubMed.
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundOlder adults with advanced chronic kidney disease (CKD) frequently experience frailty, multimorbidity, cognitive impairment and functional decline, yet these geriatric syndromes are not routinely evaluated in nephrology services. Comprehensive Geriatric Assessment (CGA) can support personalised treatment decisions and optimise outcomes, but its role in CKD stages 4-5 remains unclear. This systematic review examined the impact of CGA on clinical outcomes, decision-making, and implementation within nephrology services.
methodsA systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE and Embase were searched from inception to November 2025, alongside clinical trials registries. Studies were eligible if they included adults aged ≥ 60 years with CKD stages 4-5 (predialysis, dialysis-dependent, and/or undergoing kidney transplant evaluation) and evaluated CGA or a nephrology-tailored multidomain geriatric assessment incorporating ≥ 3 geriatric domains. Outcomes of interest included clinical outcomes, shared decision-making, and/or implementation features. Risk of bias was assessed using ROBINS-I and CASP tools. Narrative synthesis was undertaken due to study heterogeneity.
resultsOf 6,978 records identified, 5,923 were screened after duplicate removal; 39 full texts were assessed and six studies met inclusion criteria. CGA consistently identified high burdens of frailty, cognitive impairment, and functional limitation. CGA domains were strongly associated with mortality, hospitalisation, dialysis initiation, and transplant listing outcomes. Across conservative care, dialysis, and transplant pathways, CGA informed shared decision-making, treatment planning, and advance care planning. Implementation was feasible but heterogeneous, with variation in CGA models, fidelity, and workforce requirements.
conclusionCGA meaningfully informs prognostic assessment and shared decision-making in older adults with advanced CKD, particularly in conservative kidney management (CKM) and transplant pathways. However, evidence for improving clinical outcomes remains limited, underscoring the need for rigorous trials and implementation frameworks to establish CGA as a core component of kidney care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.