---
title: "ESRD Start Encounter"
slug: "ckd-key-concepts-esrd-start-encounter"
updated: 2023-05-16T21:46:49Z
published: 2023-05-16T21:46:49Z
canonical: "docs.ursahealth.com/ckd-key-concepts-esrd-start-encounter"
stale: true
---

> ## Documentation Index
> Fetch the complete documentation index at: https://docs.ursahealth.com/llms.txt
> Use this file to discover all available pages before exploring further.

# ESRD Start Encounter

## **Definition**

The encounter that marks the progression of a CKD patient from stage 5 or below to ESRD. There are two types of such encounters: (1) admissions with a kidney transplantation surgery performed; and (2) dialysis encounters; in all cases, the patient must be found to meet the criteria for ESRD as of the encounter, and only the first qualifying encounter in the patient’s life is included.

## **Purpose**

Used in the URSA-CKD module to inform certain performance measures focusing on the circumstances of the patient’s transition to ESRD (e.g., whether it was emergent).

## **Related objects**

- [**Patient Timelines Master for URSA-CKD Concepts**](/v1/docs/ckd-objects-patient-timelines-master-for-ursa-ckd-concepts)
- [**Kidney Transplantation Surgery Encounter**](/v1/docs/ckd-objects-kidney-transplantation-surgery-encounter)
- [**Dialysis Encounters**](/v1/docs/ckd-objects-dialysis-encounters)
- [**ESRD Start Encounters**](/v1/docs/ckd-objects-esrd-start-encounters)

## **Detailed narrative of logic**

1. As implemented in **ESRD Start Encounters**, ESRD starts are identified either by the presence of an inpatient admission with a performed kidney transplantation surgery and without dialysis, obtained from **Kidney Transplantation Surgery Encounter**, or by a dialysis encounter, obtained from **Dialysis Encounter****s**. In both cases, the encounter must also mark the start of the first ESRD period in the patient’s life, with the patient’s ESRD timeline obtained from **Patient Timelines Master for URSA-CKD Concepts**.
2. Note that, with this approach, patients whose transition to ESRD status occurs without a contemporaneous encounter — e.g., via the CMS MMR ESRD flag — are not included in the resulting set of encounters.
3. ESRD start encounters are classified as either kidney transplant or dialysis encounter; as noted above, encounters with both a kidney transplantation surgery and performed dialysis are considered dialysis starts under the assumption that the patient likely underwent dialysis prior to the kidney transplantation surgery.