Estimating Kidney Failure Risk Using Electronic Medical Records

Felipe S. Naranjo; Yingying Sang; Shoshana H. Ballew; Nikita Stempniewicz; Stephan C. Dunning; Andrew S. Levey; Josef Coresh; Morgan E. Grams

doi:10.34067/KID.0005592020

Article Figures & Data

Figures

Tables
Additional Files

Download figure
Open in new tab
Download powerpoint

Tables

Figures
Additional Files

View popup

Table 1.

Baseline characteristics of patients with eGFR <60 ml/min per 1.73 m², by health care organization

Health Care Organization Identification	N	Age (mean, SD)	% Female	eGFR (mean, SD)	% Diabetes	% Hypertension
1	18,273	71 (10)	60	47 (11)	40	85
2	28,690	74 (10)	61	47 (11)	36	87
3	14,560	72 (10)	62	48 (11)	31	72
4	17,833	73 (10)	61	47 (11)	37	85
5	12,342	73 (10)	58	49 (10)	35	80
6	83,266	71 (11)	61	48 (11)	29	67
7	9309	73 (10)	61	47 (10)	35	88
8	10,160	71 (10)	58	47 (11)	43	88
9	16,463	65 (12)	54	49 (11)	32	75
10	65,990	71 (11)	60	47 (11)	40	86
11	6239	62 (12)	56	45 (13)	61	85
12	17,078	73 (10)	62	47 (11)	35	83
13	16,794	73 (9)	59	48 (10)	45	86
14	20,977	71 (12)	57	46 (12)	31	68
15	12,442	75 (9)	55	46 (12)	34	84
16	11,396	74 (10)	56	46 (12)	37	73
17	44,092	72 (10)	61	47 (11)	36	80
18	15,774	71 (11)	58	45 (12)	30	79
19	13,057	72 (10)	51	47 (12)	30	67
20	32,055	73 (10)	61	48 (11)	39	88
21	21,408	71 (12)	55	45 (13)	2	3
22	14,068	71 (10)	60	46 (12)	37	80
23	17,831	73 (9)	58	48 (11)	32	74
24	38,390	71 (11)	59	48 (11)	31	76
25	14,967	72 (10)	61	47 (11)	32	83
26	12,122	72 (11)	55	44 (13)	22	40
27	23,954	72 (10)	59	47 (11)	35	80
28	28,114	72 (11)	59	46 (12)	29	66
29	10,281	73 (11)	62	48 (11)	35	73
30	23,110	72 (10)	59	47 (11)	37	79
31	18,669	71 (10)	60	47 (11)	21	53
32	22,847	72 (12)	54	47 (12)	7	17
33	9443	73 (10)	61	46 (11)	29	60
34	7591	67 (13)	53	46 (13)	30	66
35	103,583	72 (10)	61	48 (10)	35	83
36	104,536	72 (11)	58	46 (12)	24	53
37	11,916	70 (11)	57	44 (14)	36	70
38	12,583	74 (10)	57	48 (11)	42	87
39	14,096	70 (12)	58	45 (13)	6	13
Total	976,299	72 (11)	59	47 (11)	32	71

View popup

Table 2.

Proportion with albumin-creatinine ratio testing according to “look-back” window

Health Care Organization Identification	N	Albumin-Creatinine Ratio Within 1 yr, N (%)	Albumin-Creatinine Ratio Within 2 yr, N (%)	Albumin-Creatinine Ratio Within 3 yr, N (%)
1	18,273	3393 (18.6)	4446 (24.3)	4996 (27.3)
2	28,690	4242 (14.8)	5515 (19.2)	6065 (21.1)
3	14,560	2342 (16.1)	2816 (19.3)	3044 (20.9)
4	17,833	2425 (13.6)	3044 (17.1)	3356 (18.8)
5	12,342	1631 (13.2)	2564 (20.8)	3143 (25.5)
6	83,266	16,522 (19.8)	20,734 (24.9)	21,403 (25.7)
7	9309	1055 (11.3)	1304 (14.0)	1335 (14.3)
8	10,160	848 (8.4)	1061 (10.4)	1170 (11.5)
9	16,463	2775 (16.9)	3357 (20.4)	3586 (21.8)
10	65,990	8374 (12.7)	11,185 (17.0)	12,624 (19.1)
11	6239	1712 (27.4)	2174 (34.9)	2420 (38.8)
12	17,078	3169 (18.6)	4105 (24.0)	4534 (26.6)
13	16,794	2281 (13.6)	2945 (17.5)	3209 (19.1)
14	20,977	2884 (13.8)	3722 (17.7)	4315 (20.6)
15	12,442	1777 (14.3)	2144 (17.2)	2331 (18.7)
16	11,396	1588 (13.9)	2101 (18.4)	2308 (20.3)
17	44,092	7708 (17.5)	9213 (20.9)	9843 (22.3)
18	15,774	1150 (7.3)	1550 (9.8)	1671 (10.6)
19	13,057	822 (6.3)	1050 (8.0)	1102 (8.4)
20	32,055	7263 (22.7)	8640 (27.0)	9076 (28.3)
21	21,408	1758 (8.2)	2365 (110.1)	2753 (12.9)
22	14,068	709 (5.0)	891 (6.3)	960 (6.8)
23	17,831	12,169 (68.3)	13,003 (72.9)	13,154 (73.8)
24	38,390	3201 (8.3)	4206 (11.0)	4985 (13.0)
25	14,967	2540 (17.0)	2987 (20.0)	3092 (20.7)
26	12,122	1615 (13.3)	1760 (14.5)	1760 (14.5)
27	23,954	3087 (12.9)	3881 (16.2)	4262 (17.8)
28	28,114	2496 (8.9)	2795 (9.9)	2856 (10.2)
29	10,281	1139 (11.1)	1209 (11.8)	1210 (11.8)
30	23,110	2263 (9.8)	2492 (10.8)	2495 (10.8)
31	18,669	978 (5.2)	1086 (5.8)	1121 (6.0)
32	22,847	3380 (14.8)	4129 (18.1)	4592 (20.1)
33	9443	1060 (11.2)	1299 (17.8)	1415 (15.0)
34	7591	926 (12.2)	1249 (16.4)	1419 (18.7)
35	103,583	13,458 (13.0)	16,968 (16.4)	18,355 (17.7)
36	104,536	10,239 (9.8)	12,189 (11.7)	13,391 (12.8)
37	11,916	1499 (12.6)	1932 (16.2)	2015 (16.9)
38	12,583	3410 (27.1)	4109 (32.7)	4503 (35.8)
39	14,096	1798 (12.8)	2141 (15.2)	2179 (15.5)
Total	976,299	141,686 (14.5)	174,360 (17.9)	188,048 (19.3)

View popup

Table 3.

Characteristics of patients, on the basis frequency and type of albuminuria testing within 3 yr

Characteristic	Group 1: Has Albumin-Creatinine Ratio Test	Group 2: Has Protein-To-Creatinine Ratio Test	Group 3: Has Proteinuria Dipstick Test	Group 4: Has No Albuminuria Test
N (%)	188,048 (19)	16,130 (2)	354,627 (36)	417,494 (43)
Age, yr	71 (10)	69 (13)	72 (11)	72 (11)
Female sex (%)	55	48	62	58
eGFR (ml/min per 1.73 m²)	46 (11)	37 (13)	47 (11)	47 (11)
Median (IQR) ACR/PCR/dipstick level, (mg/g, mg/g, category)	21 (8–79)	210 (100–670)	Negative	NA
Diabetes	75.5%	33.8%	20.1%	21.2%
Hypertension	84.7%	79.0%	71.3%	63.8%
ESKD events (N)	8972	2045	7976	10,660
ESKD incidence, events per 1000 person-yr, 95% CI	10.49 (10.27–10.71)	31.95 (30.60–33.37)	5.31 (5.19–5.42)	5.98 (5.87–6.09)
Death incidence, events per 1000 person-yr, 95% CI	60.55 (60.03–61.08)	80.47 (78.35–82.65)	74.93 (74.50–75.38)	68.32 (67.94–68.71)

Group 1, available ACR test. Group 2, available PCR, but no available ACR. Group 3, available urine dipstick protein level measurement, but no available ACR or PCR. Group 4, no form of albuminuria measured. 95% CI, 95% confidence interval IQR, interquartile range; ACR, albumin-creatinine ratio; PCR, protein-to-creatinine ratio.

View popup

Table 4.

C-statistics in groups with albumin-creatinine ratio, protein-to-creatinine ratio/dipstick, and no urine testing within 3 yr

Health Care Organization Identification	Group 1: Has Albumin-Creatinine Ratio Test		Group 2: Has Protein-To-Creatinine Ratio Test		Group 3: Has Proteinuria Dipstick Test		Group 4: Has No Albuminuria Test
Health Care Organization Identification	Three-variable	Four-variable	Three-variable	Four-variable	Three-variable	Four-variable	Three-variable
1	0.840	0.888			0.894	0.922	0.872
2	0.860	0.912			0.902	0.917	0.915
3	0.794	0.836			0.915	0.935	0.865
4	0.886	0.909			0.911	0.929	0.931
5	0.869	0.907
6	0.856	0.894	0.790	0.804	0.876	0.888	0.885
7	0.866	0.920					0.900
8	0.905	0.921			0.920	0.940	0.911
9	0.852	0.898					0.931
10	0.826	0.861	0.840	0.864	0.876	0.895	0.887
11	0.862	0.919			0.840	0.863	0.877
12	0.859	0.892			0.925	0.937	0.869
13	0.815	0.879	0.867	0.888	0.867	0.892
14	0.843	0.884	0.845	0.877	0.851	0.841	0.903
15	0.894	0.912			0.887	0.900	0.923
16	0.867	0.900	0.803	0.830	0.916	0.916	0.889
17	0.864	0.903			0.885	0.902	0.901
18	0.871	0.925	0.840	0.866			0.926
19	0.880	0.897	0.817	0.823	0.855	0.864	0.897
20	0.867	0.909			0.898	0.914	0.921
21	0.854	0.891			0.879	0.887	0.922
22	0.812	0.849			0.898	0.906	0.881
23	0.867	0.897			0.902	0.917	0.960
24	0.903	0.930			0.901	0.918	0.868
25	0.891	0.932			0.892	0.913	0.927
26	0.833	0.877			0.817	0.824	0.882
27	0.851	0.905			0.897	0.908	0.862
28	0.838	0.889	0.763	0.789	0.851	0.868	0.867
29	0.852	0.876			0.884	0.894	0.889
30	0.762	0.854			0.879	0.889	0.898
31	0.844	0.885			0.904	0.915	0.906
32	0.842	0.882			0.877	0.868	0.921
33	0.860	0.895			0.835	0.833	0.930
34	0.870	0.915			0.843	0.850	0.932
35	0.829	0.881	0.852	0.884	0.859	0.881	0.889
36	0.844	0.883			0.861	0.878	0.881
37	0.833	0.868	0.794	0.814	0.887	0.901	0.929
38	0.897	0.930
39	0.845	0.893			0.869	0.888	0.887
Median C-statistic	0.856	0.895	0.828	0.847	0.885	0.897	0.899
	Meta-analyzed difference in C-statistic		Meta-analyzed difference in C-statistic		Meta-analyzed difference in C-statistic
	0.039 (0.036–0.043)		0.022 (0.017–0.026)		0.012 (0.010–0.015)

Group 1, available ACR test. Group 2, available PCR, but no available ACR. Group 3, available urine dipstick protein level measurement, but no available ACR or PCR. Group 4, no form of albuminuria measured. Bold indicates that the difference in C-statistic between the 4-variable and 3-variable KFRE in the group is statistically significant. ACR, albumin-creatinine ratio; PCR, protein-to-creatinine ratio.