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Validity of administrative database coding for kidney disease: a systematic review.
Meghan E O Vlasschaert1, Shayna A D Bejaimal, Daniel G Hackam
1Department of Medicine, University of Western Ontario, London, Canada.
Summary
Administrative databases are increasingly used for renal care, but code validity for acute kidney injury (AKI) and chronic kidney disease (CKD) is often poor. Careful interpretation is crucial to avoid bias in research and policy decisions.
Area of Science:
- Nephrology
- Health Informatics
- Biostatistics
Background:
- Health administrative databases are vital for renal care and policy development.
- The accuracy of codes for acute kidney injury (AKI) and chronic kidney disease (CKD) in these databases is critical for reliable information.
- This study systematically reviews the validity of these renal codes.
Purpose of the Study:
- To assess the validity of diagnostic and procedural codes for AKI and CKD in health administrative databases.
- To identify factors influencing code validity and potential biases in research and policy.
Main Methods:
- Systematic review of observational studies published up to June 2009.
- Included studies validated renal codes against reference standards like patient charts or laboratory values.
- Searched 13 medical databases, including 25 studies from 4 countries.
Main Results:
- Code validation for AKI was assessed in 9 studies, and for CKD in 19 studies.
- Sensitivity for both AKI and CKD codes was generally poor (median 29% and 41%, respectively).
- Positive predictive values were variable, and using only dialysis data improved validity. Laboratory values in reference standards reduced sensitivity.
Conclusions:
- While administrative databases offer utility, their analyses must be approached with caution due to variable code validity.
- Poor code validity can introduce bias, necessitating judicious interpretation of findings for renal care and policy.
- Limitations included missing data in primary studies, impacting comprehensive analysis.
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