Gaps in Etiologic Classification of Chronic Kidney Disease in US Veterans: A Retrospective Cohort Study
- 1University of Virginia
Abstract
Many patients living with chronic kidney disease (CKD) may not have a clearly identified cause, which can be a barrier to targeted therapies. We assessed the assignment of CKD etiologies in the national Veterans Health Administration (VHA) electronic health record data, overall and by demographics. We identified regular VHA users aged 18 - 100 years with new-onset CKD based on persistent eGFR <60 ml/min/1.73m2 occurring 2005-2015. CKD etiologies were identified by administrative codes over 3 years before and after the incident CKD date. Etiologies were categorized as diabetic, hypertensive/vascular, obstructive/urologic, glomerular, cystic/congenital, and tubulointerstitial. CKD was considered recognized, but without etiology, if only a general CKD code was present. Logistic regression models assessed disparities by sex and race/ethnicity after adjustment for age, US Census region, and calendar year of incident CKD. Among 452,851 Veterans with CKD, 42.5% were assigned at least one etiology. Hypertensive/vascular (24.5%) was the most common. After adjustment, non-Hispanic Black Veterans and Hispanic Veterans were more likely to be assigned an etiologically-specific diagnosis than non-Hispanic White Veterans (OR 1.61 and 1.23, respectively, each p<0.001). Differences were greater at younger ages. Non-Hispanic Black Veterans were much more likely to be assigned a hypertensive/vascular etiology (OR 2.17; p<0.001), but both non-Hispanic Black and Hispanic Veterans were more likely than White veterans to be assigned diabetic and glomerular etiologies as well (each p<0.001). Women were much less likely to be assigned an etiology overall, and in all categories, compared to men (each p<0.001). Women were less likely to have CKD recognized even if etiology was not assigned. Overall, the assignment of an etiology for CKD is low among U.S. Veterans, particularly among women, possibly due to poor CKD recognition. Types of etiologies assigned differ by race/ethnicity, which may represent true etiologic difference or biased assignment.
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BibTeX
@misc{scialla2026gaps,
title = {{Gaps in Etiologic Classification of Chronic Kidney Disease in US Veterans: A Retrospective Cohort Study}},
author = {J. J. Scialla and K. Dwomoh and B. Silverberg and A. Gerber and W. Yu and F. Heng and A. T. Kelley and A. Cheung and G. Yan},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.22.26365664},
url = {https://www.medrxiv.org/content/10.64898/2026.10.22.26365664v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Gaps in Etiologic Classification of Chronic Kidney Disease in US Veterans: A Retrospective Cohort Study
AU - J. J. Scialla
AU - K. Dwomoh
AU - B. Silverberg
AU - A. Gerber
AU - W. Yu
AU - F. Heng
AU - A. T. Kelley
AU - A. Cheung
AU - G. Yan
PY - 2026
DA - 2026/10/22
PB - medRxiv
DO - 10.64898/2026.10.22.26365664
UR - https://www.medrxiv.org/content/10.64898/2026.10.22.26365664v1
AB - Many patients living with chronic kidney disease (CKD) may not have a clearly identified cause, which can be a barrier to targeted therapies. We assessed the assignment of CKD etiologies in the national Veterans Health Administration (VHA) electronic health record data, overall and by demographics. We identified regular VHA users aged 18 - 100 years with new-onset CKD based on persistent eGFR <60 ml/min/1.73m2 occurring 2005-2015. CKD etiologies were identified by administrative codes over 3 years before and after the incident CKD date. Etiologies were categorized as diabetic, hypertensive/vascular, obstructive/urologic, glomerular, cystic/congenital, and tubulointerstitial. CKD was considered recognized, but without etiology, if only a general CKD code was present. Logistic regression models assessed disparities by sex and race/ethnicity after adjustment for age, US Census region, and calendar year of incident CKD. Among 452,851 Veterans with CKD, 42.5% were assigned at least one etiology. Hypertensive/vascular (24.5%) was the most common. After adjustment, non-Hispanic Black Veterans and Hispanic Veterans were more likely to be assigned an etiologically-specific diagnosis than non-Hispanic White Veterans (OR 1.61 and 1.23, respectively, each p<0.001). Differences were greater at younger ages. Non-Hispanic Black Veterans were much more likely to be assigned a hypertensive/vascular etiology (OR 2.17; p<0.001), but both non-Hispanic Black and Hispanic Veterans were more likely than White veterans to be assigned diabetic and glomerular etiologies as well (each p<0.001). Women were much less likely to be assigned an etiology overall, and in all categories, compared to men (each p<0.001). Women were less likely to have CKD recognized even if etiology was not assigned. Overall, the assignment of an etiology for CKD is low among U.S. Veterans, particularly among women, possibly due to poor CKD recognition. Types of etiologies assigned differ by race/ethnicity, which may represent true etiologic difference or biased assignment.
ER -