Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations
Kidney International, vol. 103, pp. 53–69
Abstract
The availability of electronic health records and access to a large number of routine measurements of serum creatinine and urinary albumin enhance the possibilities for epidemiologic research in kidney disease. However, the frequency of health care use and laboratory testing is determined by health status and indication, imposing certain challenges when identifying patients with kidney injury or disease, when using markers of kidney function as covariates, or when evaluating kidney outcomes. Depending on the specific research question, this may influence the interpretation, generalizability, and/or validity of study results. This review illustrates the heterogeneity of working definitions of kidney disease in the scientific literature and discusses advantages and limitations of the most commonly used approaches using 3 examples. We summarize ways to identify and overcome possible biases and conclude by proposing a framework for reporting definitions of exposures and outcomes in studies of kidney disease using routinely collected health care data.
Authors 23
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Juan Jesús Carrero corresponding
Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden. Electronic address: juan.jesus.carrero@ki.se
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Leiden University · Brigham and Women's Hospital · Harvard University · Leiden University Medical Center · Karolinska Institutet
Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Aarhus University · Aarhus University Hospital
Affiliation as printed
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Aarhus University · Aarhus University Hospital
Affiliation as printed
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Affiliation as printed
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Affiliation as printed
Division of Population Health and Genomics, University of Dundee, Dundee, UK
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Aarhus University · Aarhus University Hospital
Affiliation as printed
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark; Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
Department of Biomedicine, Aarhus University, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Aarhus University · Aarhus University Hospital
Affiliation as printed
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Affiliation as printed
Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
Department of Health Research and Methodology, McMaster University, Hamilton, Ontario, Canada
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Affiliation as printed
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
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Leiden University Medical Center
Affiliation as printed
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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University Medical Center Groningen · University of Groningen
Affiliation as printed
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Affiliation as printed
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Amsterdam UMC Location University of Amsterdam · Amsterdam Public Health
Affiliation as printed
ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics, Meibergdreef, Amsterdam, Netherlands
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Affiliation as printed
Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
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University of Tennessee Health Science Center
Affiliation as printed
Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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University of Ottawa · Ottawa Hospital Research Institute
Affiliation as printed
Department of Medicine, the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Inserm · Université de Versailles Saint-Quentin-en-Yvelines · Centre de recherche en Epidémiologie et Santé des Populations
Affiliation as printed
CESP (Center for Research in Epidemiology and Population Health), Clinical Epidemiology Team, University Paris-Saclay, University Versailles-Saint Quentin, Inserm U1018, Villejuif, France
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Aarhus University · Aarhus University Hospital
Affiliation as printed
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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University of Tsukuba · London School of Hygiene & Tropical Medicine
Affiliation as printed
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
Department of Health Services Research, University of Tsukuba, Ibaraki, Japan
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Dorothea Nitsch corresponding
London School of Hygiene & Tropical Medicine · Chiang Mai University
Affiliation as printed
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; UK Renal Registry, UK Kidney Association, Bristol, UK. Electronic address: Dorothea.Nitsch@lshtm.ac.uk
Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
UK Renal Registry, UK Kidney Association, Bristol, UK
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