Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Renal Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Pharmacoepidemiol Drug Saf. 2022 Apr;31(4):467-475. doi: 10.1002/pds.5398. Epub 2021 Dec 23.
Prior validation studies of claims-based definitions of chronic kidney disease (CKD) using ICD-9 codes reported overall low sensitivity, high specificity, and variable but reasonable PPV. No studies to date have evaluated the accuracy of ICD-10 codes to identify a US patient population with CKD.
We assessed the accuracy of claims-based algorithms to identify adults with CKD Stages 3-5 compared with laboratory values in a subset (~40%) of a US commercial insurance claims database (Optum's de-identified Clinformatics® Data Mart Database). We calculated the positive predictive value (PPV) of one or two ICD-9 (2012-2014) or ICD-10 (2016-2018) codes for CKD compared with a lab-based estimated glomerular filtration rate (eGFR) occurring within prespecified windows (±90 days, ±180 days, ±365 days) of the ICD-based CKD code(s).
The study population ranged between 104 774 and 161 305 patients (ICD-9 cohorts) and between 285 520 and 373 220 patients (ICD-10 cohorts). The mean age was 74.4 years (ICD-9) and 75.6 years (ICD-10) and the median eGFR was 48 ml/min/1.73 m . The algorithm of two CKD codes compared with a lab value ±90 days of the first code achieved the highest PPV (PPV 86.36% [ICD-9] and 86.07% [ICD-10]). Overall, ICD-10 based codes had comparable PPVs to ICD-9 based codes and all ICD-10 based algorithms had PPVs >80%. The algorithm of one CKD code compared with laboratory value ±180 days maintained the PPV above 80% but still retained a large number of patients (PPV 80.32% [ICD-9] and 81.56% [ICD-10]).
An ICD-10-based definition of CKD identified with sufficient accuracy a patient population with CKD Stages 3-5. Our findings suggest that claims databases could be used for future real-world research studies in patients with CKD Stages 3-5.
先前使用 ICD-9 代码对基于索赔的慢性肾脏病 (CKD) 定义进行的验证研究报告称，总体敏感性较低，特异性较高，阳性预测值 (PPV) 存在差异但合理。迄今为止，尚无研究评估 ICD-10 代码用于识别美国 CKD 患者人群的准确性。
我们评估了基于索赔的算法在 Optum 的去识别 Clinformatics®Data Mart Database（一个美国商业保险索赔数据库的子集（约 40%））中识别 CKD 阶段 3-5 成年人的准确性，与实验室值进行比较。我们计算了一个或两个 ICD-9（2012-2014 年）或 ICD-10（2016-2018 年）代码与实验室基于肾小球滤过率估计值 (eGFR) 的 CKD 的 PPV（发生在 ICD 基于 CKD 代码的 ±90 天、±180 天、±365 天的预设窗口内）。
研究人群在 ICD-9 队列中范围在 104774 至 161305 例之间，在 ICD-10 队列中范围在 285520 至 373220 例之间。平均年龄为 74.4 岁（ICD-9）和 75.6 岁（ICD-10），中位 eGFR 为 48 ml/min/1.73 m。两个 CKD 代码的算法与第一个代码实验室值 ±90 天相比，实现了最高的 PPV（ICD-9 为 86.36%，ICD-10 为 86.07%）。总体而言，基于 ICD-10 的代码与基于 ICD-9 的代码具有可比的 PPV，所有基于 ICD-10 的算法的 PPV 均>80%。与实验室值 ±180 天相比，一个 CKD 代码的算法保持了 80%以上的 PPV，但仍保留了大量患者（ICD-9 为 80.32%，ICD-10 为 81.56%）。
基于 ICD-10 的 CKD 定义以足够的准确性确定了 CKD 阶段 3-5 的患者人群。我们的发现表明，索赔数据库可用于未来 CKD 阶段 3-5 患者的真实世界研究。
