Faculty Collaboration Database

Identification of Major Adverse Kidney Events Within the Electronic Health Record. J Med Syst 2016 Jul;40(7):167

Date

05/29/2016

Pubmed ID

27234478

Pubmed Central ID

PMC5791539

DOI

10.1007/s10916-016-0528-z

Scopus ID

2-s2.0-84971378917 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

Acute kidney injury is common among critically ill adults and is associated with increased mortality and morbidity. The Major Adverse Kidney Events by 30 days (MAKE30) composite of death, new renal replacement therapy, or persistent renal dysfunction is recommended as a patient-centered outcome for pragmatic trials involving acute kidney injury. Accurate electronic detection of the MAKE30 endpoint using data within the electronic health record (EHR) could facilitate the use of the EHR in large-scale kidney injury research. In an observational study using prospectively collected data from 200 admissions to a single medical intensive care unit, we tested the performance of electronically-extracted data in identifying the MAKE30 composite compared to the reference standard of two-physician manual chart review. The incidence of MAKE30 on manual-review was 16 %, which included 8.5 % for in-hospital mortality, 3.5 % for new renal replacement therapy, and 8.5 % for persistent renal dysfunction. There was strong agreement between the electronic and manual assessment of MAKE30 (98.5 % agreement [95 % CI 96.5-100.0 %]; kappa 0.95 [95 % CI 0.87-1.00]; P < 0.001), with only three patients misclassified by electronic assessment. Performance of the electronic MAKE30 assessment was similar among patients with and without CKD and with and without a measured serum creatinine in the 12 months prior to hospital admission. In summary, accurately identifying the MAKE30 composite outcome using EHR data collected as a part of routine care appears feasible.

Author List

Semler MW, Rice TW, Shaw AD, Siew ED, Self WH, Kumar AB, Byrne DW, Ehrenfeld JM, Wanderer JP

Author

Jesse Ehrenfeld MD, MPH Sr Associate Dean, Director, Professor in the Advancing a Healthier Wisconsin Endowment department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Kidney Injury
Adult
Age Factors
Aged
Creatinine
Electronic Health Records
Female
Hospital Mortality
Humans
Intensive Care Units
Male
Middle Aged
Prospective Studies
Renal Insufficiency
Renal Replacement Therapy
Reproducibility of Results
Severity of Illness Index
Sex Factors
Socioeconomic Factors