Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL 60141, USA.
Am J Nephrol. 2012;36(6):542-8. doi: 10.1159/000345460. Epub 2012 Dec 4.
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.
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.
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).
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.
慢性肾脏病（CKD）和脊髓损伤与疾病（SCI/D）是退伍军人中常见且代价高昂的病症。然而，人们对 SCI/D 成人患者中的 CKD 知之甚少。
我们对 2006 年所有 VA 设施中患有 SCI/D 的退伍军人进行了横断面分析。CKD 的定义为估算肾小球滤过率（eGFR）<60 ml/min/1.73 m(2)，并按标准 eGFR 分层进行分类。eGFR 通过两种方式计算：(a) 肾脏病饮食改良公式（MDRD）和 (b) 针对 SCI/D 的经验校正因子（MDRD-SCI/D）。采用逻辑回归模型来检验患者特征与 CKD 之间的关系。
在 9333 名具有可获得 eGFR 的 SCI/D 退伍军人中，根据 MDRD-SCI/D 方程（35.2%），CKD 的比例明显高于根据 MDRD 方程（10.2%）。在调整分析中，虽然年龄较大（>65 岁的比值比 [OR] 为 2.53；95%置信区间 [CI]：2.21-2.89）、女性（OR 2.18；95% CI：1.62-2.92）和非创伤性病因（OR 1.39；95% CI：1.23-1.57）与 CKD 的患病几率增加相关，但黑人种族（OR 0.64；95% CI：0.56-0.72）和受伤时间≥10 年（OR 0.76；95% CI：0.67-0.86）与 CKD 的患病几率降低相关。患有 CKD 的 SCI/D 退伍军人的 CKD 诊断代码和肾脏科就诊记录都很少（分别为 27.51%和 6.58%）。
使用最近经过验证的 MDRD 方程及其针对 SCI/D 的校正因子版本，超过三分之一的 SCI/D 退伍军人患有 CKD，这比使用传统的 MDRD 估计值高出 3 倍以上。
