Defining measures of kidney function in observational studies using routine health care data: methodological and reporting considerations

Kidney Int. 2023 Jan;103(1):53-69. doi: 10.1016/j.kint.2022.09.020. Epub 2022 Oct 22.


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.

Keywords: albuminuria; chronic kidney disease (CKD); creatinine; epidemiology; estimated glomerular filtration rate (eGFR); routinely collected health care data.

Publication types

  • Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Albuminuria / diagnosis
  • Creatinine
  • Glomerular Filtration Rate
  • Humans
  • Kidney
  • Kidney Diseases* / diagnosis
  • Kidney Diseases* / epidemiology
  • Kidney Diseases* / therapy
  • Kidney Function Tests
  • Renal Insufficiency, Chronic* / diagnosis
  • Renal Insufficiency, Chronic* / therapy


  • Creatinine