Concordance Between the Minimum Data Set Kidney Impairment I1500 Item and eGFR Records in Nursing Homes

To evaluate the concordance between the Minimum Data Set (MDS) version 3.0 I1500 item and estimated glomerular filtration rate (eGFR) laboratory values for identifying kidney impairment among nursing home (NH) residents.

A retrospective cohort study was conducted using data from 8 multistate, multifacility NH chains from January 1, 2018, to July 1, 2022. MDS 3.0 assessments with a complete I1500 item were linked to eGFR values measured on the assessment reference date or within 7 days prior.

The study included NH residents with at least 1 MDS 3.0 assessment linked to a matching eGFR within a 7-day look-back window.

Concordance between the 2 measures was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and Cohen's kappa statistics, overall and stratified by pandemic periods (pre-pandemic, early pandemic, and late pandemic). We used an eGFR threshold of <60 mL/min/1.73 m² for the primary analysis and <45 for the secondary analysis.

The study included 454,436 MDS assessments from 225,557 NH residents. Using an eGFR threshold of <60, agreement with the MDS I1500 item was 60.3% (kappa = 0.19), with 25.8% sensitivity and 92.3% specificity. At the <45 threshold, agreement rose to 71.8% (kappa = 0.22), with 29.9% sensitivity and 89.2% specificity.

The MDS 3.0 I1500 measure demonstrated fair agreement, low sensitivity, and high specificity for identifying kidney impairment compared with eGFR values. Cross-referencing federally mandated MDS data with eGFR data could improve kidney impairment identification and care planning in NHs.