Identification of Major Adverse Kidney Events Within the Electronic Health Record

  • Matthew W. Semler
  • Todd W. Rice
  • Andrew D. Shaw
  • Edward D. Siew
  • Wesley H. Self
  • Avinash B. Kumar
  • Daniel W. Byrne
  • Jesse M. Ehrenfeld
  • Jonathan P. Wanderer
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


Acute kidney injury is common among critically ill adults and is associated with increased mortality and morbidity. The Major Adverse Kidney Events by 30 days (MAKE30) composite of death, new renal replacement therapy, or persistent renal dysfunction is recommended as a patient-centered outcome for pragmatic trials involving acute kidney injury. Accurate electronic detection of the MAKE30 endpoint using data within the electronic health record (EHR) could facilitate the use of the EHR in large-scale kidney injury research. In an observational study using prospectively collected data from 200 admissions to a single medical intensive care unit, we tested the performance of electronically-extracted data in identifying the MAKE30 composite compared to the reference standard of two-physician manual chart review. The incidence of MAKE30 on manual-review was 16 %, which included 8.5 % for in-hospital mortality, 3.5 % for new renal replacement therapy, and 8.5 % for persistent renal dysfunction. There was strong agreement between the electronic and manual assessment of MAKE30 (98.5 % agreement [95 % CI 96.5–100.0 %]; kappa 0.95 [95 % CI 0.87–1.00]; P < 0.001), with only three patients misclassified by electronic assessment. Performance of the electronic MAKE30 assessment was similar among patients with and without CKD and with and without a measured serum creatinine in the 12 months prior to hospital admission. In summary, accurately identifying the MAKE30 composite outcome using EHR data collected as a part of routine care appears feasible.


Acute kidney injury Major adverse kidney events Intensive care unit Electronic health record 



The authors would like to thank Michael Plante, Karen McCarthy, Hongjuan Blazer, and Stephen Baker from the Vanderbilt Anesthesia and Perioperative Informatics Research (VAPIR) Division.

Authors Contributions

Study concept and design: M.W.S., T.W.R., A.D.S, E.D.S., J.M.E., J.P.W. Acquisition of data: M.W.S., T.W.R., J.M.E., J.P.W.; Analysis and interpretation of data: M.W.S., T.W.R., D.W.B., J.M.E., J.P.W.; Drafting of the manuscript: M.W.S., J.P.W.; Critical revision of the manuscript for important intellectual content: M.W.S., T.W.R., A.D.S, E.D.S., W.H.S., A.B.K., D.W.B., J.M.E., J.P.W.; Statistical analysis: M.W.S., D.W.B., J.P.W.; Study supervision: M.W.S., T.W.R., A.D.S, J.M.E., J.P.W. Matthew W. Semler and Jonathan P. Wanderer had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Matthew W. Semler conducted and is responsible for the data analysis. No portion of this work has been previously presented.

Compliance with Ethical Standards

Source of Funding and Conflicts of Interest

Biostatistical support was provided by Vanderbilt Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH). M.W.S. was supported by a National Heart, Lung, and Blood Institute (NHLBI) T32 award (HL087738 09). E.W.S. received support from the Vanderbilt Center for Kidney Disease (VCKD) and the VA Health Services Research and Development Service (HSR&D IIR-13-073). W.H.S was supported in part by K23GM110469 from the National Institute of General Medical Sciences. J.P.W received support from by the Foundation for Anesthesia Education and Research (FAER, Schaumburg, IL, USA) and Anesthesia Quality Institute (AQI, Schaumburg, IL, USA)’s Health Service Research Mentored Research Training Grant (HSR-MRTG). The funding institutions had no role in (1) conception, design, or conduct of the study, (2) collection, management, analysis, interpretation, or presentation of the data, or (3) preparation, review, or approval of the manuscript. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors declare no potential conflicts of interest. T.W.R. reported serving on an advisory board for Avisa Pharma, LLC and as a DSMB member for GlaxoSmithKline PLC. W.H.S. reported serving on advisory boards for BioFire Diagnostics, Inc and Venaxis, Inc.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Matthew W. Semler
    • 1
  • Todd W. Rice
    • 1
  • Andrew D. Shaw
    • 2
  • Edward D. Siew
    • 3
  • Wesley H. Self
    • 4
  • Avinash B. Kumar
    • 2
  • Daniel W. Byrne
    • 5
  • Jesse M. Ehrenfeld
    • 2
    • 6
  • Jonathan P. Wanderer
    • 2
    • 6
  1. 1.Division of Allergy, Pulmonary, and Critical Care MedicineVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of AnesthesiologyVanderbilt University Medical CenterNashvilleUSA
  3. 3.Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for AKI (VIP-AKI)Vanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of Emergency MedicineVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of BiostatisticsVanderbilt University Medical CenterNashvilleUSA
  6. 6.Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleUSA

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