Mr Thái Bình Trần1,2, Professor Jeanette Thom3,4,5, Dr Shaundeep Sen1,2,6, Associate Professor Kelly Lambert1, Associate Professor Ria Arnold1,2
1School of Medical, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia, 2Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia, 3School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 4Sydney Musculoskeletal Health, The University of Sydney, Sydney, Australia, 5School of Health Sciences, Faculty of Medicine, University of New South Wales, Randwick, Australia, 6Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
Biography:
I’m an exercise physiologist and PhD candidate at the University of Wollongong and Concord Repatriation General Hospital. My research sits at the intersection of clinical care and health service delivery, using mixed methods to improve the delivery of exercise and physical activity for people with chronic kidney disease and to address the challenges faced by interest-holders in this setting. Alongside my research, I’m a practising exercise physiologist with experience in physical and psychosocial disability care. I’m passionate about bridging the gap between research and practice to improve patient outcomes and enhance quality of life.
Aim:
To improve understanding of comorbidity and physical function patterns in tertiary kidney care and explore their implications for clinical practice.
Background:
Multimorbidity and physical disability are common in nephrology, contributing to poor outcomes, reduced quality of life, and high healthcare utilisation. Although clinicians routinely encounter these challenges, the relationship between comorbidity and functional impairments, such as pain and mobility limitations, remains poorly understood. Identifying these patterns is critical to stratify risk, guide rehabilitation, and improve patient outcomes.
Methods:
We conducted a secondary cross-sectional analysis of routinely collected service audit data (May 2024–March 2025) from a public nephrology outpatient unit in Sydney, Australia. The KDQOL pain scale, IPOS-R mobility scale, and Short Physical Performance Battery were used to assess self-reported pain, mobility, and objective functional capacity. Active comorbidities were recorded. Exploratory factor analysis was conducted to identify clusters of comorbidity and physical function.
Results:
Among 473 patients (41% female, median eGFR 33, median age 74 years), 16% reported severe–very severe pain, 14% reported severe–overwhelming burden related to poor mobility, and 14% were classified as physically disabled. Four clusters were identified, explaining 29% of the variance in patients’ comorbid and functional profiles: musculoskeletal impairment (pain, poor mobility, arthropathies, osteopathies), cardiometabolic disorders (ischaemic heart disease, hyperlipidaemia, glucose intolerance), neuropsychiatric disorders (anxiety, depression, cerebral palsy, spinal cord disorders), and heart–kidney failure (heart failure, valvular heart disease, arrhythmia, low eGFR).
Conclusions:
The identification of comorbidity and physical function clusters provides a foundation for developing management strategies that address complex care needs, reduce disability progression, and improve patient outcomes. These findings offer a roadmap to help nephrology teams implement targeted rehabilitation and design integrated care pathways to strengthen frailty management.