{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T17:45:10Z","timestamp":1761327910072,"version":"build-2065373602"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000291","name":"Kidney Research UK","doi-asserted-by":"crossref","award":["AHPF_001_20220705"],"award-info":[{"award-number":["AHPF_001_20220705"]}],"id":[{"id":"10.13039\/501100000291","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Patients with biochemical evidence of chronic kidney disease (CKD) without a diagnostic code (uncoded CKD) in primary care are at increased risk of death, acute kidney injury (AKI), and unplanned hospital care. Uncoded CKD is highly prevalent and there is no data to evaluate whether patients with uncoded CKD were at an increased risk of COVID-19 death. Aim: to assess whether patients with uncoded CKD stages 3\u20135 were at increased risk of death and COVID-19 deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Descriptive and inferential analyses to measure adjusted hazard of death, and COVID-19 death in patients with CKD stages 3\u20135 from 2.85 million primary care patients in Greater Manchester, England. Sensitivity analyses using propensity score matching and competing risk regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Coded CKD stages 3 and 4 (versus uncoded) were associated with significantly lower adjusted hazards of death (HR 0.81, CIs 0.77\u20130.86, p=&lt;0.0001; HR 0.45, CIs 0.34\u20130.60, p=&lt;0.0001, respectively), and COVID-19 death (HR 0.74, CIs 0.55\u20130.99, p\u2009=\u20090.03; HR 0.55, CIs 0.30\u20130.99, p\u2009=\u20090.045, respectively). Descriptive analyses were conducted for patients with CKD stage 5 due to low numbers of patients with uncoded CKD stage 5, precluding survival analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our retrospective cohort study suggests that clinical coding is a digital intervention associated with a lower adjusted hazard of death and COVID-19 death in patients with CKD stages 3 and 4, and should be considered a key element in the organisation and delivery of care for people with CKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0333881","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T17:39:14Z","timestamp":1761327554000},"page":"e0333881","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the impact of clinical coding in chronic kidney disease on risk of death and COVID-19 death"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7767-4308","authenticated-orcid":true,"given":"Stuart","family":"Stewart","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip A.","family":"Kalra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evangelos","family":"Kontopantelis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Blakeman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Tilston","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Smeeta","family":"Sinha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"pone.0333881.ref001","unstructured":"Kidney Research UK. Kidney disease: a UK public health emergency - The health economics of kidney disease to 2023 [Internet]. 2023 Jun [cited 2024 Jan 9]. Available from: https:\/\/www.kidneyresearchuk.org\/wp-content\/uploads\/2023\/06\/Economics-of-Kidney-Disease-full-report_accessible.pdf"},{"issue":"10225","key":"pone.0333881.ref002","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"395","author":"GBD Chronic Kidney Disease Collaboration","year":"2020","journal-title":"Lancet"},{"key":"pone.0333881.ref003","unstructured":"Nitsch D, Caplin B, Hull S, Wheeler D, Kim L, Cleary F. National Chronic Kidney Disease Audit. National Report: Part 1. 2017 Jan, p. 1\u201384."},{"issue":"1","key":"pone.0333881.ref004","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1186\/s12916-024-03555-0","article-title":"Chronic kidney disease: detect, diagnose, disclose-a UK primary care perspective of barriers and enablers to effective kidney care","volume":"22","author":"S Stewart","year":"2024","journal-title":"BMC Med"},{"issue":"10","key":"pone.0333881.ref005","article-title":"CODE-EHR best-practice framework for the use of structured electronic health-care records in clinical research","volume":"4","author":"D Kotecha","year":"2022","journal-title":"Lancet Digit Health"},{"issue":"8","key":"pone.0333881.ref006","article-title":"Effective coding is key to the development and use of the WHO Essential Diagnostics List","volume":"1","author":"J McKnight","year":"2019","journal-title":"Lancet Digit Health"},{"key":"pone.0333881.ref007","unstructured":"SNOMED International. What is SNOMED-CT [Internet]. SNOMED International. 2024 [cited 2024 Nov 19]. Available from: https:\/\/www.snomed.org\/what-is-snomed-ct"},{"key":"pone.0333881.ref008","unstructured":"World Health Organization. ICD-11 [Internet]. [cited 2024 Nov 19]. Available from: https:\/\/icd.who.int\/en"},{"issue":"700","key":"pone.0333881.ref009","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp20X713105","article-title":"Uncoded chronic kidney disease in primary care: a cross-sectional study of inequalities and cardiovascular disease risk management","volume":"70","author":"M Molokhia","year":"2020","journal-title":"Br J Gen Pract"},{"key":"pone.0333881.ref010","unstructured":"Mudie K, Cleary F, Caplin B, Wheeler D, Hull S, Nitsch D. National Chronic Kidney Disease Audit. National Report: Part 2. 2017 Dec, p. 1\u2013140."},{"issue":"758","key":"pone.0333881.ref011","doi-asserted-by":"crossref","first-page":"425","DOI":"10.3399\/BJGP.2025.0228","article-title":"Coded and uncoded chronic kidney disease: an explainer","volume":"75","author":"S Stewart","year":"2025","journal-title":"Br J Gen Pract"},{"key":"pone.0333881.ref012","unstructured":"Office for Health Improvement & Disparities. CVDPREVENT | Quality Improvement Tool [Internet]. CVDPREVENT. 2023 [cited 2023 Dec 14]. Available from: www.cvdprevent.nhs.uk\/home"},{"key":"pone.0333881.ref013","unstructured":"Department of Health and Social Care. Clinically extremely vulnerable receive updated guidance in line with new national restrictions [Internet]. GOV.UK. 2020 [cited 2024 Apr 14]. Available from: https:\/\/www.gov.uk\/government\/news\/clinically-extremely-vulnerable-receive-updated-guidance-in-line-with-new-national-restrictions"},{"key":"pone.0333881.ref014","unstructured":"Department of Health and Social Care. Joint Committee on Vaccination and Immunisation: advice on priority groups for COVID-19 vaccination. 2020 Dec."},{"key":"pone.0333881.ref015","unstructured":"NHS England. Coronavirus \u00bb Update on guidance for clinically extremely vulnerable individuals and actions for acute trusts [Internet]. [cited 2025 Apr 9]. Available from: https:\/\/www.england.nhs.uk\/coronavirus\/documents\/c0830-update-on-guidance-for-clinically-extremely-vulnerable-individuals-and-actions-for-acute-trusts\/"},{"year":"2020","author":"UK Kidney Association","key":"pone.0333881.ref016"},{"key":"pone.0333881.ref017","unstructured":"NHS Greater Manchester. GM Care Record [Internet]. GM Care Record. [cited 2024 Nov 18]. Available from: https:\/\/gmwearebettertogether.com\/gm-care-record\/"},{"key":"pone.0333881.ref018","unstructured":"National Institute for Health and Care Excellence. Chronic kidney disease | Health topics A to Z | CKS | NICE [Internet]. 2021 [cited 2021 Sep 26]. Available from: https:\/\/cks.nice.org.uk\/topics\/chronic-kidney-disease\/"},{"key":"pone.0333881.ref019","unstructured":"Secretary of State for Health and Social Care. Covid-19 \u2013 Notice under Regulation 3(4) of the Health Service Control of Patient Information Regulations 2002. 2022."},{"year":"2021","author":"National Kidney Foundation","key":"pone.0333881.ref020"},{"issue":"1","key":"pone.0333881.ref021","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/s12882-025-03967-x","article-title":"Uncoded chronic kidney disease prevalence in secondary care: a retrospective audit with population health implications","volume":"26","author":"S Dolan","year":"2025","journal-title":"BMC Nephrol"},{"issue":"7821","key":"pone.0333881.ref022","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"OpenSAFELY: factors associated with COVID-19 death in 17 million patients","volume":"584","author":"EJ Williamson","year":"2020","journal-title":"Nature"},{"issue":"5","key":"pone.0333881.ref023","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-067386","article-title":"Prevalence of undiagnosed stage 3 chronic kidney disease in France, Germany, Italy, Japan and the USA: results from the multinational observational REVEAL-CKD study","volume":"13","author":"N Tangri","year":"2023","journal-title":"BMJ Open"},{"issue":"684","key":"pone.0333881.ref024","article-title":"Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London","volume":"69","author":"SA Hull","year":"2019","journal-title":"Br J Gen Pract"},{"issue":"673","key":"pone.0333881.ref025","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3399\/bjgp18X697997","article-title":"The National CKD Audit: a primary care condition that deserves more attention","volume":"68","author":"SA Hull","year":"2018","journal-title":"Br J Gen Pract"},{"issue":"702","key":"pone.0333881.ref026","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp21X714389","article-title":"Inequalities in CKD management can be overcome","volume":"71","author":"S Hull","year":"2020","journal-title":"Br J Gen Pract"},{"issue":"687","key":"pone.0333881.ref027","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp19X705497","article-title":"Using chronic kidney disease trigger tools for safety and learning: a qualitative evaluation in East London primary care","volume":"69","author":"N Thomas","year":"2019","journal-title":"Br J Gen Pract"},{"issue":"4","key":"pone.0333881.ref028","doi-asserted-by":"crossref","DOI":"10.1093\/ckj\/sfaf049","article-title":"Integrated primary and secondary care optimizes the management of people with CKD-the LUCID project","volume":"18","author":"RW Major","year":"2025","journal-title":"Clin Kidney J"},{"issue":"5","key":"pone.0333881.ref029","doi-asserted-by":"crossref","DOI":"10.1007\/s40620-025-02299-1","article-title":"Association between primary care physician\u2013nephrologist collaboration and clinical outcomes in patients with stage 5 chronic kidney disease: a JOINT-KD cohort study","volume":"38","author":"M Murakami","year":"2025","journal-title":"J Nephrol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333881","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T17:39:21Z","timestamp":1761327561000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0333881"}},"subtitle":[],"editor":[{"given":"Diego","family":"Moriconi","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":29,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,10,24]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0333881","relation":{},"ISSN":["1932-6203"],"issn-type":[{"type":"electronic","value":"1932-6203"}],"subject":[],"published":{"date-parts":[[2025,10,24]]}}}