Exact Dx · Before you sign · P19 synthetic data · demonstration · printed Fri Nov 13, 2026 04:55 PM

P19 woman, 70 · outpatient visit AI-drafted

Needs a look The note says chronic kidney disease stage 4; two results 95 days apart are in the G3b range (filtering rate 37.3 on 2026-08-09 and 34.5 on 2026-11-12), not the stage written.

The note unsigned draft · Thu Nov 12, 2026 04:00 PM

The results

The note is compared with the patient's own measurements, in both directions. Kidney filtering rate (eGFR) is estimated from creatinine, age and sex.

Kidney function over time Needs a look

2026-08-09 creatinine 1.5 mg/dL · filtering rate 37.3 (G3b range)
2026-11-12 creatinine 1.6 mg/dL · filtering rate 34.5 (G3b range)

Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.

Show the details

Mode: measurements only (no diagnosis is named). The check runs the same way on clinician-typed and AI-drafted notes (as declared by the source system).

Kidney function (eGFR persistence) · kdigo_ckd_2024@1.1

eGFR: Stage in the note differs from the computed category criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)

eGFR 34.5 on 2026-11-12 (lab row L-0044) and eGFR 37.3 on 2026-08-09 (lab row L-0043), 95 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (the range both values meet). Note: the stage in the kidney-function statement (quoted below) differs from the persistent GFR category.

From the draft note: chronic kidney disease stage 4

Both directions
What the labs show that the note doesn't say	Criteria met; the note has a statement
What the note says that the labs don't support	Statement present; its stage is missing or differs from the computed category

not met: Urine ACR >= 30 mg/g on two values at least 90 days apart (needed only when eGFR >= 60) (kdigo_ckd_2024@1.1)
no urine ACR on file
met: Latest creatinine below 1.5x the lowest value in the previous 365 days (otherwise: possible acute change; repeat needed) (kdigo_ckd_2024@1.1)
1.6 / 1.5 = 1.07x
Rows: L-0043, L-0044
met: No condition on record that makes the estimating equation unreliable (maintenance dialysis, kidney transplant, pregnancy, limb amputation or another extreme of muscle mass) (kidney_exclusions@1.0)
none on record for this encounter date
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0043 (34.9, 2026-08-09) and L-0044 (32.3, 2026-11-12), 95 days apart; persistent category G3b (the range both values meet)
Rows: L-0043, L-0044
met: Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation) (kdigo_ckd_2024@1.1)
pair L-0043 (37.3, 2026-08-09) and L-0044 (34.5, 2026-11-12), 95 days apart; persistent category G3b (the range both values meet)
Rows: L-0043, L-0044
met: Values used are steady-state (local convention: values from an admission meeting the creatinine-change criteria are excluded) (kdigo_ckd_2024@1.1)
no values excluded

Creatinine change during this admission · kdigo_aki_2012@1.1

Creatinine change: Does not apply to this visit

Not assessed: outpatient visit: the creatinine-change check runs on inpatient encounters only.

Try one creatinine value

One value is never a confirmed stage: the persistence rule needs a repeat at least 90 days later.

The record of this check

Run

RUN-00019 · seed · Fri Nov 13, 2026 04:55 PM · audit entry #1613

Engine

kidney-engine 2.0

Rule versions

ckd_epi_2009@1.0 · Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)
ckd_epi_2021@1.0 · Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)
kdigo_aki_2012@1.1 · KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)
kdigo_ckd_2024@1.1 · KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)
kidney_compare@1.1 · Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update
kidney_exclusions@1.0 · KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list
lab_units@1.1 · KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)

Note reading

word list + model, agreement required · model: ok · kidney function: stated · creatinine change: silent

Agreed statements

chronic kidney disease stage 4 (characters 140-170); Chronic kidney disease stage 4 (characters 253-283)

Provenance

AI-drafted, as declared by the source system (context only: never an input to the rules)

Results side

measurement replay hash 3e83050808c403e9b60f1ab54fa780985e3b6c4d73caad2d64a22fe7e85a95e0 (computed from structured values only)

Replay hash

9710e9318337bfb70af8bef4ffb691bf32b7d58b3305459a4c9ae15ce48a2dab

Decisions

none yet

Revisions

KN-P19-1

Every creatinine row on file, with the filtering rate by the 2021 equation (and the 2009 equation as a drift check)
Row	Collected	Creatinine	Age	2021	Range	2009	Used
`L-0043`	2026-08-09 09:00	1.5	70	37.3	G3b	34.9	yes
`L-0044`	2026-11-12 14:00	1.6	70	34.5	G3b	32.3	yes

P19 woman, 70 · outpatient visit ◆ AI-drafted