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Validation of diagnostic coding for chronic kidney disease using a Japanese hospital-based database
Momiji Otani-Kono1, Shungo Imai2, Masami Tsuchiya1
1Division of Drug Informatics, Faculty of Pharmacy, Keio University, Tokyo, Japan.
Insights
The validity of International Classification of Diseases 10th Revision (ICD-10) codes for chronic kidney disease (CKD) in Japan was evaluated. The overall positive predictive value (PPV) was 57.9%, indicating limited accuracy for CKD diagnosis using these codes.
Area of Science:
- Nephrology
- Medical Informatics
- Public Health
Background:
- The accuracy of International Classification of Diseases 10th Revision (ICD-10) codes for chronic kidney disease (CKD) in Japan remains unevaluated.
- This study addresses the critical need to assess the validity of CKD-related ICD-10 codes within the Japanese healthcare system.
Purpose of the Study:
- To evaluate the validity of ICD-10 codes used for identifying patients with chronic kidney disease (CKD) in Japan.
- To determine the positive predictive value (PPV), sensitivity, specificity, and negative predictive value (NPV) of these codes.
Main Methods:
- A retrospective cohort study utilized the JMDC hospital-based database (Japan).
- Patients with two serum creatinine measurements (90-365 days apart) were identified; CKD was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria (eGFR < 60 mL/min/1.73 m²).
- The PPV, sensitivity, specificity, and NPV of specific CKD-related ICD-10 codes were calculated.
Main Results:
- The study included 618,208 patients; 59,139 received CKD-related ICD-10 codes, and 172,657 met KDIGO criteria.
- Overall PPV was 57.9%, sensitivity 19.8%, specificity 94.4%, and NPV 75.2%.
- Specific codes (N183, N184, N185, N189) demonstrated PPVs exceeding 80%.
Conclusions:
- The overall PPV of ICD-10 codes for CKD in Japan (57.9%) is lower than in the US (86.1%) and Canada (60.1%).
- Certain ICD-10 codes show potential utility for identifying CKD patients, despite overall limited sensitivity.
- Further validation and potential refinement of coding practices are suggested for accurate CKD surveillance.
Background:
The validity of the International Classification of Diseases 10th Revision (ICD-10) codes for chronic kidney disease (CKD) in Japan have not been evaluated. In this study we evaluated the validity of CKD-related ICD-10 codes in Japan.
Methods:
This retrospective cohort study used the JMDC hospital-based database, which comprises claims and laboratory data from over 1,000 medical institutions in Japan. Patients who underwent two serum creatinine measurements between April 2014 and August 2022 were identified; the second measurement was obtained 90-365 days after the first. The estimated glomerular filtration rate (eGFR) was calculated. CKD was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria: an eGFR < 60 mL/min/1.73 m2 for both measurements. Markers of kidney damage such as albuminuria were unavailable. Patients assigned CKD-related ICD-10 codes (N183, N184, N185, N189, N19, E102, E112, E142, and I120) within 365 days of the initial serum creatinine measurement were identified. Subsequently, the positive predictive value (PPV), sensitivity, specificity, and negative predictive value (NPV) were calculated.
Results:
Among the 618,208 included patients, 59,139 were assigned CKD-related ICD-10 codes and 172,657 met the KDIGO criteria. The overall PPV, sensitivity, specificity, and NPV were 57.9%, 19.8%, 94.4%, and 75.2%, respectively. In contrast, the PPVs of N183, N184, N185, and N189 exceeded 80%.
Conclusions:
In Japan, the PPV of the ICD-10 codes for CKD was 57.9%, marginally lower than values reported in the United States (86.1%) and Canada (60.1%). Several ICD-10 codes may be useful for identifying patients with CKD, despite their limited sensitivity.
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