title: Prevalence of chronic kidney disease in patients with spinal cord injuries/disorders.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) and spinal cord injury and disorders (SCI/D) are common and costly conditions among Veterans. However, little is known about CKD among adults with SCI/D.
  
  
  METHODS
  We conducted cross-sectional analyses of Veterans with SCI/D across all VA facilities in 2006. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2) and categorized by standard eGFR strata. eGFR was calculated in two ways: (a) the Modification of Diet in Renal Disease (MDRD) equation and (b) the MDRD equation + an empirically derived correction factor for SCI/D (MDRD-SCI/D). Logistic regression models were used to examine the relationship between patient characteristics and CKD.
  
  
  RESULTS
  Among 9,333 SCI/D Veterans with an available eGFR, the proportion with CKD was substantially higher based on the MDRD-SCI/D equation (35.2%) than based on the MDRD equation (10.2%). In adjusted analyses, while older age (OR for >65 years = 2.53; 95% CI: 2.21-2.89), female sex (OR 2.18; 95% CI: 1.62-2.92), and a non-traumatic cause for injury (OR 1.39; 95% CI: 1.23-1.57) were associated with an increased odds of CKD, black race (OR 0.64; 95% CI: 0.56-0.72) and a duration of injury of ≥10 years (OR 0.76; 95% CI: 0.67-0.86) were associated with a decreased odds of CKD. Diagnostic codes for CKD and nephrology visits were infrequent for SCI/D Veterans with CKD (27.51 and 6.58%, respectively).
  
  
  CONCLUSIONS
  Using a recently validated version of the MDRD equation with a correction factor for SCI/D, over 1 in 3 Veterans with SCI/D had CKD, which is more than 3-fold higher than when traditional MDRD estimation is used.
authors.affiliation: Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA. Michael.Fischer3@va.gov
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fischer
authors.forename: V Ram
authors.initials: VR
authors.lastname: Krishnamoorthi
authors.forename: Bridget M
authors.initials: BM
authors.lastname: Smith
authors.forename: Charlesnika T
authors.initials: CT
authors.lastname: Evans
authors.forename: Justin R
authors.initials: JR
authors.lastname: St Andre
authors.forename: Shanti
authors.initials: S
authors.lastname: Ganesh
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Huo
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D055641:Mathematical Concepts; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D012737:Sex Factors; D013118:Spinal Cord Diseases / Q000150:complications* / Q000453:epidemiology*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology