PRM44 - Evaluation of Electronic Health Record Data Quality to Assess the Clinical Indices of Anemia in Dialysis Patients

Abstract

To assess the quality and completeness of data in eHRs from an LDO in the US, focusing on demographic and clinical variables. We used Kahn’s framework (Analytic Methods, 2012) to objectively assess data quality from all de-identified patients across 2,900 US dialysis centers in 2015 (~229,000). Specific focus was made on the following quality domains as they related to anemia associated with CKD and its treatment: 1) missing values and anomalies in data, 2) accurate relationships between data tables, 3) temporal relationships, and 4) logical events. Demographic, clinical, and treatment variables included age, sex, hemoglobin (Hb), iron parameters (transferrin saturation [TSAT], ferritin), and erythropoietin stimulating agent (ESA) use were descriptively assessed using means, ranges, counts, and proportions. Results were analyzed with and without lab results that were missing or entered as zero. Low missingness was seen for age (0.08%), sex (0.04%), and dialysis treatment (0%) data. TSAT was recorded for 93% of patients (range 0-100%; mean 30.6%) and ferritin recorded for 93% of patients (range 0-15,743 ng/mL; mean 733 ng/mL). Hb labs were recorded for 96% of the LDO cohort (range 0-46.8 g/dL; mean 10.9 g/dL, same result obtained without zero values). Among patients with available Hb concentrations, 78% had non-zero Hb values <10.0 g/dL (the KDIGO suggested threshold for treatment). Of these patients, 11% were below this threshold for a span of at least 90 days based on subsequent lab draw dates. Of patients with Hb <10 g/dL, 98% were receiving an ESA. Using Kahn’s framework, certain demographic features, anemia treatment, and iron indices were consistently recorded in eHR LDO data. This provides support for the use of these LDO eHR anemia-related variables for future research. Most patients with Hb labs were anemic (78%) but received ESA treatment as suggested by KDIGO guidelines.