Article Text

  1. M. W. Greenwell,
  2. S. J.A. Zaidi,
  3. T. M. Mangold,
  4. N. D. Grant,
  5. B. M. Wall
  1. Veterans Affairs Medical Center, Memphis, TN


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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