Abstract: SA-PO765
Can Rapidly Progressing CKD Patients Be Identified Using Billing Codes?
Session Information
- CKD: Epidemiology, Risk Factors, Prevention - III
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 1901 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Jalal, Kabir, University at Buffalo, Amherst, New York, United States
- Venuto, Rocco C., Erie County Medical Center, Buffalo, New York, United States
- Anand, Edwin J., Erie County Medical Center, Buffalo, New York, United States
- Arora, Pradeep, Veterans Affairs Medical Center, Buffalo, New York, United States
Background
The International Classification of Diseases (ICD) coding system is the industry standard diagnostic coding tool. However, ICD codes often do not reflect the clinical diagnosis, particularly among Chronic Kidney disease (CKD) patients. This study evaluates the diagnostic accuracy in identifying rapidly progressing CKD patients using CKD-related ICD codes in a large insurer database.
Methods
Serial observations from 2007 through 2014 were examined. 216,529 individuals had valid serum creatinine measurements. The progression of CKD using a longitudinal mixed-model was contrasted with that documented by ICD codes. Rapid progressors (yearly eGFR loss greater than 4 ml/min/1.73m^2) were identified. Clinical diagnosis according to the Kidney Disease Outcomes Quality Initiative (KDOQI) was compared to diagnosis using ICD codes.
Results
323 rapid progressors were identified among the 10,927 CKD patients qualifying for inclusion in the clinical progression analysis. ICD codes identified 83 of these, for a sensitivity of 25.7% and specificity 95.09%. Of 28,762 laboratory-confirmed CKD patients, 9,249 had a qualifying ICD code, for a sensitivity of 16%. Of 187767 patients without laboratory-confirmed CKD, 182,359 did not have a qualifying ICD code, for a specificity of 97.12%.
Conclusion
This study leverages 7 years of serial observations, facilitating identification of disease progression, and depicts the novel finding that ICD-codes display poor capacity to identify rapidly progressing CKD patients when compared to gold standard KDOQI guidelines, and further demonstrates the limitations of coding in CKD diagnosis management. This study further defines the limitations of ICD codes in addressing diagnosis of disease severity or disease progression for clinical or epidemiological purposes.
ROC Curves for Detecting CKD (Left) and Rapid Progressors (Right) for Comorbid Conditions
Funding
- Clinical Revenue Support