{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T18:48:16Z","timestamp":1791398896243,"version":"4.3.3"},"reference-count":20,"publisher":"Cambridge University Press (CUP)","issue":"1","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"unspecified","delay-in-days":295,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ASHE"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S2732494X25101666_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) is prevalent among US Veterans. Identifying patients undergoing dialysis in real-time is crucial for implementing patient safety measures, including stewardship interventions, such as medication dosing adjustments. Limited feasible and accurate tools exist for near-real-time identification. This study aimed to develop a renal replacement therapy (RRT) flag using structured data in the Veterans Health Administration (VHA) electronic health record (EHR).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25101666_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Data from Veterans who underwent cardiovascular implantable electronic device (CIED) procedures (9\/2015\u201312\/2019) were linked to US Renal Data Systems (USRDS) data. Potential identifiers included outpatient hemodialysis procedure records, community care hemodialysis consults, ICD-10 diagnoses, and serum creatinine (SCr) &gt;4 mg\/dL. USRDS served as the comparison standard, and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Logistic regression determined the area under the curve (AUC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25101666_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 37,706 CIED procedures on 34,994 Veterans, 967 patients (2.6%) were identified by USRDS as ever receiving RRT (hemodialysis and peritoneal dialysis or transplant), with 520 (1.4%) actively receiving RRT at the time of CIED. The RRT flag, combining \u22654 outpatient procedures in the prior 30 days, \u22651 consult in the prior year, and\/or SCr &gt;4 mg\/dL, achieved an AUC of 0.976 (95% CI: 0.97\u20130.98), with high sensitivity (0.96; 95% CI: 0.94\u20130.97) and specificity (0.99; 95% CI: 0.99\u20131.00). The PPV was 0.70 (95% CI: 0.67\u20130.74). Performance was slightly lower when consults were replaced with ICD codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S2732494X25101666_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>We developed an accurate electronic flag using structured data to identify active RRT within VHA among Veterans undergoing invasive procedures, supporting patient safety and care adjustments. This flag addresses a crucial patient safety gap and supports expansion of stewardship efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/ash.2025.10166","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T07:39:37Z","timestamp":1761205177000},"source":"Crossref","is-referenced-by-count":1,"title":["Development of a feasible and portable electronic flag for near-real-time identification of renal replacement therapy in the Veterans Health Administration"],"prefix":"10.1017","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7270-3643","authenticated-orcid":false,"given":"Samuel W.","family":"Golenbock","sequence":"first","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dipandita","family":"Basnet","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"},{"name":"Boston University School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4484-0445","authenticated-orcid":false,"given":"Hillary J.","family":"Mull","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"},{"name":"Boston University Chobanian & Avedisian School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5599-0924","authenticated-orcid":false,"given":"Rebecca","family":"Lamkin","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Harvey","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlena","family":"Shin","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3711-0639","authenticated-orcid":false,"given":"Judith M.","family":"Strymish","sequence":"additional","affiliation":[{"name":"Greater Los Angeles VA Healthcare System"},{"name":"UCLA David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9821-9646","authenticated-orcid":false,"given":"Sarah","family":"Leatherman","sequence":"additional","affiliation":[{"name":"Center for Health Optimization and Implementation Research (CHOIR)"},{"name":"Greater Los Angeles VA Healthcare System"},{"name":"VA Cooperative Studies Program"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Greater Los Angeles VA Healthcare System"},{"name":"VA Cooperative Studies Program"},{"name":"Boston University Chobanian and Avedisian School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9658-5124","authenticated-orcid":false,"given":"Westyn","family":"Branch-Elliman","sequence":"additional","affiliation":[{"name":"Greater Los Angeles VA Healthcare System"},{"name":"UCLA David Geffen School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"S2732494X25101666_ref9","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.06840712"},{"key":"S2732494X25101666_ref17","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-023-00784-z"},{"key":"S2732494X25101666_ref7","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.13022"},{"key":"S2732494X25101666_ref18","doi-asserted-by":"publisher","DOI":"10.1186\/s12882-018-1122-z"},{"key":"S2732494X25101666_ref8","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofz360.965"},{"key":"S2732494X25101666_ref15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.21785"},{"key":"S2732494X25101666_ref10","unstructured":"10. De-Implementation of Inappropriate Antimicrobial Use After Cardiac Device Procedures (CIED) [NCT05020418]. 2023. https:\/\/clinicaltrials.gov\/study\/NCT05020418?term=branch-elliman&rank=2. Accessed April 12, 2024."},{"key":"S2732494X25101666_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2019.10.020"},{"key":"S2732494X25101666_ref1","doi-asserted-by":"publisher","DOI":"10.1111\/sdi.12601"},{"key":"S2732494X25101666_ref14","unstructured":"14. Veterans Health Administration (VHA). VHA Directive 1153 \u201cVHA Access To and Use of Centers for Medicare and Medicaid Services and United States Renal Data System Data\u201d. https:\/\/gcc02.safelinks.protection.outlook.com\/?url=https%3A%2F%2Fwww.va.gov%2Fvhapublications%2FViewPublication.asp%3Fpub_ID%3D9548&data=04%7C01%7C%7Cb5ade9646b6e4db9722408d9fb8b387b%7Ce95f1b23abaf45ee821db7ab251ab3bf%7C0%7C0%7C637817397621377538%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=SyDkjCXMgl3DviLR4%2Frk%2B8plxIou7TODGg4AhiUNDq0%3D&reserved=0. 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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). 2023 Researcher\u2019s Guide to the United States Renal Data System Database. 2023.\u00a0https:\/\/www.niddk.nih.gov\/about-niddk\/strategic-plans-reports\/usrds\/for-researchers\/researchers-guide. 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