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Abstract: SA-PO845

Documenting CKD in the Primary Care Electronic Health Record

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Jurkovitz, Claudine T., Christiana Care Health System, Newark, Delaware, United States
  • Dolman, Sarahfaye, MedStar Health Research Institute, Washington, District of Columbia, United States
  • Caplan, Richard, Christiana Care Health System, Newark, Delaware, United States
  • Israni, Rubeen K., AstraZeneca, Newark, Delaware, United States
  • Swanson, Sidney J., Christiana Care Health System, Newark, Delaware, United States
Background

The KDOQI guidelines recommend 2 measurements of glomerular filtration rate (GFR) <60 mL/min/1.73m2 or evidence of kidney damage at 3 months intervals or more to establish the diagnosis of chronic kidney disease (CKD). We examined whether the diagnosis of CKD in an outpatient primary care setting was documented in the Electronic Health Record (EHR) according to the GFR-based KDOQI criteria.

Methods

We used the CKD-Epi equation to assess GFR from the serum creatinine records of patients seen in a network of primary care offices from 2011 to 2015. Our study population was defined as patients 18+ with at least one GFR<60 and at least one followup visit. We excluded patients with an initial GFR<15, those in renal replacement therapy and those with a known CKD diagnosis. Followup began at the time of the first GFR<60. We calculated the time interval between the first GFR<60 and the second GFR and stratified patients into 3 categories according to their first GFR (GFR 15-<30; 30-<45; 45-<60). We used the Systematized Nomenclature of Medicine (SNOMED) codes to ascertain documentation of CKD.

Results

Our final study population included 7098 patients. Of those, 37% were male, 84% white, 15% black; 3%, 18%, and 78% had a first GFR 15-<30, 30-<45 and 45-<60 respectively. Mean age was 70. Overall 63% had a second GFR<60. A total of 4669 patients did not have a CKD diagnosis during followup. Of those, 65% met the KDOQI criteria and CKD should have been documented in the EHR. Of the 2429 patients assigned a CKD code, 41% met the KDOQI criteria, 12% had a second GFR≥60, 27% were given the diagnosis prior to the second GFR measurement, 20% had a second GFR measured within 3 months. Of our study population (n=7098), 43% met the KDOQI criteria but did not receive a documented diagnosis and 20% had a documented diagnosis but did not meet KDOQI criteria.

Conclusion

CKD diagnosis was not appropriately documented in a large number of patients. Algorithms used to identify CKD patients for population health management should not rely only on diagnosis codes but also include measurements of GFR. More resources should be developed to assist primary care physicians to enter the appropriate code in the EHR. The lack of albuminuria information in our dataset limits the interpretation of the apparent over CKD coding of those who did not meet the GFR-based KDOQI guidelines.

Funding

  • Other NIH Support