2011 National Meeting

1048 — Chronic Kidney Disease in Veterans with Spinal Cord Injury

Krishnamoorthi VR (Edward Hines Jr. VA Hospital) , Stroupe KT (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital), Smith BM (CMC3, SCI QUERI, Edward Hines Jr. VA Hospital), Evans CT (CMC3, Edward Hines Jr. VA Hospital), St. Andre JR (CMC3, Edward Hines Jr. VA Hospital), Ganesh S (CMC3, Edward Hines Jr. VA Hospital), Huo Z (CMC3, Edward Hines Jr. VA Hospital), Li K (CMC3, Edward Hines Jr. VA Hospital), Fischer MJ (CMC3, Edward Hines Jr. VA Hospital)

Objectives:
Chronic Kidney Disease (CKD) is a common and costly condition among Veterans, incurring substantial morbidity and mortality. However, little is known about CKD among Veterans with spinal cord injury and disease (SCI/D). The objective of this study is to describe the prevalence, risk factors, and recognition of CKD among Veterans with SCI/D.

Methods:
We conducted cross-sectional analyses of SCI Veterans across all VA facilities in FY2008. CKD was defined as having an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2 and categorized according to standard NKF K/DOQI eGFR stages using both the MDRD equation and the MDRD equation + validated correction factor for SCI (MDRD-SCI). Logistic regression models were used to examine the relationship between CKD and risk factors. The prevalence of diagnostic codes for CKD and nephrology visits was also examined.

Results:
Among 10,166 SCI Veterans with an available eGFR in 2008, the proportion with CKD varied significantly depending on the estimating equation used, 10.0% (MDRD) and 34.4% (MDRD-SCI). Using the MDRD-SCI equation, CKD was more common in SCI Veterans with non-traumatic (48.4%) compared with traumatic injury (29.5%), as well as those with paraplegia (38.8%) compared with tetraplegia (32.9%). In adjusted analyses, Veterans with SCI/D who were older (OR = 1.04, 95%CI:1.04-1.05), female (OR = 2.19, 95%CI:1.68-2.86), hypertensive (OR 1.64, 95%CI:1.49-1.82), diabetic (OR = 1.37, 95%CI:1.23-1.52), or depressed (OR = 1.31, 95%CI:1.18-1.45) had higher odds of having CKD than other Veterans. Among SCI Veterans with CKD in 2008, diagnostic codes for CKD were infrequently found (23.3%) and varied from 18.4% with MDRD-SCI eGFR 30-59 to 83.7% with MDRD-SCI eGFR < 15. Moreover, only 5.1% of such Veterans had a nephrology visit during FY2008 including only 26.3% with eGFR < 30.

Implications:
Using a newly validated equation to estimate kidney function in adults with SCI, we found that CKD affects over one third of SCI Veterans, more than 3-fold higher than prior conventional estimate of kidney function is used.

Impacts:
This study suggests that CKD is under-recognized in SCI/D patients. Guidelines for CKD management recommend nephrology referral for patients with low kidney function, but only a quarter of such patients with SCI had visits in 2008. Further investigation about management of CKD is needed in this vulnerable population.