Abstract
BackgroundThe development of large-scale chronic kidney disease (CKD) cohorts within the Veterans Affairs (VA) system has been limited by several factors, including the high proportion of missing race data etc. The goal of this study is to address the limitations of prior studies by creating a large cohort utilizing robust KDIGO recommendations for identifying and staging CKD.MethodsMultiple patient and administrative files from the Veterans Health Administration (VHA) National Patient Care were linked to create a national cohort of Veterans with chronic kidney disease (CKD) between January 2000 – December 2012; patients identified during this period were followed until 2015. CKD was defined for stages 1 through 5 if markers of kidney damage, specifically proteinuria, were present for at least 3 months. Estimated glomerular filtration rate (eGFR) values were calculated based on serum creatinine levels and the patient’s age, gender, and race using both the Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas.ResultsAbout 50 million observations were collected that supported a CKD diagnosis during the study period; these observations corresponded to 3,051,001 unique veterans; 80.9% were non-Hispanic white (NHW), 13.4% were non-Hispanic black (NHB), 3.6% were Hispanic, and 2.0% were in other groups. The mean age 76.7, about 97% were male and 50.2% died prior to January 2016. Among those with stage 3, 12.3% progressed to stage 4, 21.6% of those with stage 4 progressed to stage 5. We found that eGFR values calculated from serum creatinine levels identified about 98% of all patients, while about 11.4% of patients could be identified through ICD-9 codes; only 6.4% could be identified through both sources.ConclusionThis 13-year national cohort provides an important resource for answering numerous research questions in the future such as racial/ethnic disparities questions, tracking health service utilization, medication adherence, cost and health outcomes in veterans with CKD.
Highlights
The development of large-scale chronic kidney disease (CKD) cohorts within the Veterans Affairs (VA) system has been limited by several factors, including the high proportion of missing race data etc
Studies relied on the Modification of Diet in Renal Disease (MDRD) equation [13] rather than the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [14]
Multiple patient and administrative files from the Veterans Health Administration (VHA) National Patient Care were linked [15] to create a national cohort of Veterans with chronic kidney disease (CKD) from January 2000 – December 2012; patients identified during this period were followed until 2015
Summary
The development of large-scale chronic kidney disease (CKD) cohorts within the Veterans Affairs (VA) system has been limited by several factors, including the high proportion of missing race data etc. Previous studies have used several CKD definitions to form cohorts [9,10,11,12], and these all differed from the current guidelines for disease classification contained in the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease [1]. One evaluated normal kidney function using estimated glomerular filtration rate (eGFR) values alone without considering albuminuria; another included a definition for CKD based on International Classification of Diseases (ICD) diagnostic codes
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