title: Implications of different laboratory-based incident diabetic kidney disease definitions on comparative effectiveness studies.
abstract: BACKGROUND
  Comparative effectiveness studies using electronic health records (EHRs) often define chronic kidney disease (CKD) outcomes using laboratory-based definitions. Recommendations for defining CKD require multiple longitudinal measurements. The implications of applying these definitions to EHR data are poorly understood.
  
  
  METHODS
  Using a cohort of 36,025 individuals with diabetes from three health systems who initiated a new glucose-lowering medication, we compared concordance and CKD incidence rates and rate ratios for glucose-lowering medication classes for laboratory-based CKD definitions requiring one versus multiple abnormal tests.
  
  
  CONCLUSIONS
  CKD incidence rates differed more than twofold based on the definition. Reassuring for CER, incidence rate ratios for glucose-lowering medication classes on risk of developing CKD were relatively unaffected by CKD definition.
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231, USA.
authors.forename: Emily B
authors.initials: EB
authors.lastname: Schroeder
authors.forename: Glenn K
authors.initials: GK
authors.lastname: Goodrich
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Newton
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.forename: Marsha A
authors.initials: MA
authors.lastname: Raebel
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria; D057186:Comparative Effectiveness Research; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000188:drug therapy; D003928:Diabetic Nephropathies / Q000145:classification* / Q000453:epidemiology; D057286:Electronic Health Records; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D051436:Renal Insufficiency, Chronic / Q000145:classification* / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D003404:Creatinine
keywords: chronic kidney disease; comparative effectiveness research; diabetes mellitus; electronic health records