The purpose of this study was to evaluate the relationship between kidney disease (as determined by creatinine clearance (CrCl) and quantitative proteinuria, both measured from 24-hour urine samples between 1993 and 1998) and mortality in chronic spinal cord injury patients (n = 219). Computerized medical records were reviewed in 2004 (follow-up period of 6-11 years) to determine overall mortality. Patients were placed in one of four groups depending on their level of proteinuria and CrCl. Group A had preserved renal function (proteinuria ≤ 500 mg/day, CrCl ≥ 60 mL/min, n = 127). Group B had significant proteinuria but normal CrCl (proteinuria ≥ 500 mg/day, CrCl ≥ 60 mL/min, n = 45). Group C had no proteinuria but decreased CrCl (proteinuria ≤ 500 mg/day, CrCl ≤ 60 mL/min, n = 18). Group D had both significant proteinuria and decreased CrCl (proteinuria ≥ 500 mg/day, CrCl ≤ 60 mL/min, n = 29). Long-term survival was assessed by Kaplan-Meier analysis and hazard ratios were calculated. Patients with either significant proteinuria and/or decreased CrCl had significantly reduced survival when compared to those with preserved renal function (mean survival times: Group A, 108 months; Group B, 76 months, p ≤ .0001; Group C, 79 months, p ≤ .0001; Group D, 47 months, p ≤ .0001). There was no difference in survival when comparing Groups B and C (p = .614). However, there appeared to be an additive effect of proteinuria and decreased CrCl on mortality, with Group D having significantly reduced survival compared with Groups B and C (p ≤ .005 and p ≤ .05 respectively). Hazard ratios (HR) also showed an additive effect of proteinuria and decreased CrCl on mortality (as compared to Group A, Group B HR 3.09, Group C HR 3.86, Group D HR 6.99). In conclusion, proteinuria ≥ 500 mg/day and CrCl ≤ 60 mL/min are both associated with increased mortality in the chronic spinal cord injury population. There appears to be an additive effect of proteinuria and decreased CrCl on this association.
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