Implications of different laboratory-based incident diabetic kidney disease definitions on comparative effectiveness studies

J Comp Eff Res. 2014 Jul;3(4):359-69. doi: 10.2217/cer.14.25.


Background: Comparative effectiveness studies using electronic health records (EHRs) often define chronic kidney disease (CKD) outcomes using laboratory-based definitions. Recommendations for defining CKD require multiple longitudinal measurements. The implications of applying these definitions to EHR data are poorly understood.

Methods: Using a cohort of 36,025 individuals with diabetes from three health systems who initiated a new glucose-lowering medication, we compared concordance and CKD incidence rates and rate ratios for glucose-lowering medication classes for laboratory-based CKD definitions requiring one versus multiple abnormal tests.

Results & conclusion: CKD incidence rates differed more than twofold based on the definition. Reassuring for CER, incidence rate ratios for glucose-lowering medication classes on risk of developing CKD were relatively unaffected by CKD definition.

Keywords: chronic kidney disease; comparative effectiveness research; diabetes mellitus; electronic health records.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Albuminuria
  • Comparative Effectiveness Research*
  • Creatinine / blood
  • Diabetes Mellitus / drug therapy
  • Diabetic Nephropathies / classification*
  • Diabetic Nephropathies / epidemiology
  • Electronic Health Records*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Incidence
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Renal Insufficiency, Chronic / classification*
  • Renal Insufficiency, Chronic / epidemiology
  • Retrospective Studies
  • Young Adult


  • Hypoglycemic Agents
  • Creatinine