Division of Nephrology, Hennepin Healthcare and Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.
Clin J Am Soc Nephrol. 2024 Jan 1;19(1):101-107. doi: 10.2215/CJN.0000000000000371. Epub 2023 Nov 14.
How symptoms recorded in the electronic health record change during the transition to dialysis has not been fully explored. We used the Optum deidentified Integrated Claims-Clinical dataset to identify individuals with CKD stages 4 or 5 who transitioned to dialysis. We searched structured data elements from clinical notes, identified by natural language processing, for symptoms recorded across weekly intervals in the 6 months before and after dialysis initiation and estimated changes in the odds of a symptom being recorded with an interrupted time series analysis using segmented logistic regression. The cohort comprised 728 individuals (aged 68±13 years, 44% women, 56% White, 30% Black). Before dialysis initiation, 83% were recorded as having pain, 68% fatigue/weakness, 66% shortness of breath, 61% nausea/vomiting, and 37% difficulty concentrating. Before dialysis initiation, odds of pain being recorded increased (slope: odds ratio [OR] 1.02 per week, 95% confidence interval [CI], 1.01 to 1.03); initiation was associated with a decrease (intercept change: OR 0.70, 95% CI, 0.59 to 0.82). After initiation, odds of pain were unchanged (postdialysis slope: OR 1.00 per week, 95% CI, 0.99 to 1.01), although this represented an improved trajectory relative to the predialysis period (change in slope: OR 0.98 per week, 95% CI, 0.96 to 0.99). For fatigue/weakness, odds increased before initiation (OR 1.03 per week, 95% CI, 1.02 to 1.04) but decreased on initiation (OR 0.62, 95% CI, 0.51 to 0.75) and thereafter (OR 0.98 per week, 95% CI, 0.97 to 0.99), representing a reduction in slope (OR 0.95 per week, 95% CI, 0.94 to 0.97). Patterns for shortness of breath, nausea/vomiting, and difficulty concentrating were similar to those of pain. Thus, the odds of five key symptoms being recorded in the electronic health record increased over time in the 6 months before dialysis initiation, decreased immediately on initiation, and, generally, remained unchanged in the 6 months thereafter.
在向透析过渡期间，电子健康记录中症状的变化尚未得到充分探索。我们使用 Optum 去识别综合索赔-临床数据集来确定从 CKD 阶段 4 或 5 过渡到透析的患者。我们从临床记录中搜索了自然语言处理确定的结构化数据元素，以识别在透析开始前和开始后 6 个月内每周间隔记录的症状，并使用分段逻辑回归的中断时间序列分析来估计记录症状的可能性的变化。该队列包括 728 名患者（年龄 68±13 岁，44%为女性，56%为白人，30%为黑人）。在开始透析之前，83%的患者被记录为有疼痛，68%的患者有疲劳/虚弱，66%的患者有呼吸急促，61%的患者有恶心/呕吐，37%的患者有注意力不集中。在开始透析之前，疼痛被记录的可能性增加（斜率：每周 1.02 的比值比[OR]，95%置信区间[CI]，1.01 至 1.03）；开始透析与疼痛减少相关（截距变化：OR 0.70，95%CI，0.59 至 0.82）。开始透析后，疼痛的可能性没有变化（每周透析后斜率：OR 1.00，95%CI，0.99 至 1.01），尽管与透析前相比，这代表了一个改善的轨迹（斜率变化：OR 每周 0.98，95%CI，0.96 至 0.99）。对于疲劳/虚弱，开始前的可能性增加（OR 每周 1.03，95%CI，1.02 至 1.04），但开始时减少（OR 0.62，95%CI，0.51 至 0.75），此后减少（OR 每周 0.98，95%CI，0.97 至 0.99），代表斜率的减少（OR 每周 0.95，95%CI，0.94 至 0.97）。呼吸急促、恶心/呕吐和注意力不集中的模式与疼痛相似。因此，在透析前 6 个月内，电子健康记录中记录的五个关键症状的可能性随着时间的推移而增加，在开始时立即减少，并且通常在随后的 6 个月内保持不变。
