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
• Kidney Transplantation Surgery Encounter
• Dialysis Encounters
• 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 Encounters. 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.