title: Identification of Major Adverse Kidney Events Within the Electronic Health Record.
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.
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-2220 MCN, Nashville, TN, 37232-2650, USA. matthew.w.semler@vanderbilt.edu.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Semler
authors.affiliation: Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-2220 MCN, Nashville, TN, 37232-2650, USA.
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Shaw
authors.affiliation: Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI (VIP-AKI), Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Edward D
authors.initials: ED
authors.lastname: Siew
authors.affiliation: Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Avinash B
authors.initials: AB
authors.lastname: Kumar
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Byrne
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Ehrenfeld
authors.affiliation: Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Wanderer
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D003404:Creatinine / Q000097:blood; D057286:Electronic Health Records / Q000458:organization & administration* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000175:diagnosis / Q000401:mortality; D017582:Renal Replacement Therapy / Q000379:methods* / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors
chemical_list: D003404:Creatinine
keywords: Acute kidney injury; Electronic health record; Intensive care unit; Major adverse kidney events