• Rajiv Saran, Aaron Pearson, Anca Tilea, Vahakn Shahinian, Jennifer Bragg-Gresham, Michael Heung, David W Hutton, Diane Steffick, Kai Zheng, Hal Morgenstern, Brenda W Gillespie, Alan Leichtman, Eric Young, Ann M O'Hare, Michael Fischer, John Hotchkiss, Eddie Siew, Denise Hynes, Linda Fried, Daniel Balkovetz, Karen Sovern, Chuan-Fen Liu, Susan Crowley, VA-REINS Steering Committee, and VA Advisory Board.
• Department of Internal Medicine - Nephrology, University of Michigan Medical School, Ann Arbor, MI. Electronic address: rsaran@med.umich.edu.
• Am. J. Kidney Dis. 2021 Mar 1; 77 (3): 397-405.

AbstractKidney disease is a common, complex, costly, and life-limiting condition. Most kidney disease registries or information systems have been limited to single institutions or regions. A national US Department of Veterans Affairs (VA) Renal Information System (VA-REINS) was recently developed. We describe its creation and present key initial findings related to chronic kidney disease (CKD) without kidney replacement therapy (KRT). Data from the VA's Corporate Data Warehouse were processed and linked with national Medicare data for patients with CKD receiving KRT. Operational definitions for VA user, CKD, acute kidney injury, and kidney failure were developed. Among 7 million VA users in fiscal year 2014, CKD was identified using either a strict or liberal operational definition in 1.1 million (16.4%) and 2.5 million (36.3%) veterans, respectively. Most were identified using an estimated glomerular filtration rate laboratory phenotype, some through proteinuria assessment, and very few through International Classification of Diseases, Ninth Revision coding. The VA spent ∼$18 billion for the care of patients with CKD without KRT, most of which was for CKD stage 3, with higher per-patient costs by CKD stage. VA-REINS can be leveraged for disease surveillance, population health management, and improving the quality and value of care, thereby enhancing VA's capacity as a patient-centered learning health system for US veterans.Copyright © 2020. Published by Elsevier Inc.

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