{"patient_id":"P21","encounter_id":"KE-P21","note_id":"KN-P21-1","signed":false,"origin":"clinician","origin_label":"Clinician-typed","origin_note":"as declared by the source system","needs_look":1,"needs_look_kidney":0,"surfaced":[{"source":"kidney","family":"kidney"},{"source":"library","family":"haemoglobin"}],"model":{"off":false,"failed":false,"degraded":false},"run_id":"RUN-00021","replay_hash":"8c92a7c383369887c1cafae379fdf6d2f5d1151e4ba44cf600b4442970378d91","measurement_replay_hash":"e202f1a0f2811363a71fc8b8d16de2c9adfa13a0fb0c9f0931e2ee9ced7abcf9","engine":"kidney-engine 2.0","rules":[{"rule":"ckd_epi_2009@1.0","source":"Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)","url":"https://www.acpjournals.org/doi/10.7326/0003-4819-150-9-200905050-00006"},{"rule":"ckd_epi_2021@1.0","source":"Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)","url":"https://www.kidney.org/ckd-epi-creatinine-equation-2021"},{"rule":"kdigo_aki_2012@1.1","source":"KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)","url":"https://kdigo.org/guidelines/acute-kidney-injury/"},{"rule":"kdigo_ckd_2024@1.1","source":"KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"kidney_compare@1.1","source":"Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update","url":"https://www.cms.gov/medicare/coding-billing/icd-10-codes"},{"rule":"kidney_exclusions@1.0","source":"KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"},{"rule":"lab_units@1.1","source":"KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)","url":"https://kdigo.org/guidelines/ckd-evaluation-and-management/"}],"last_replay":null,"library":{"run_id":"LRUN-00021","encounter_id":"KE-P21","note_id":"KN-P21-1","config":"library_default_set@1.0","engine":"library-engine 1.0","replay_hash":"d3b77c1742ff3199c3a491162d6139367a331c165e499f2a1b24161d9ec795ed","measurement_replay_hash":"49afec875af6d407f7af79f87f1b6b1ecf880d70d52b98a2550b6620d8b0261b","surfaced":[{"family":"haemoglobin","topic":"Haemoglobin","direction":"UNSUPPORTED","status":"needs_look","label":"Needs a look","icon":"●","lead":"The note says ","quote":"Anemia","text":", but no haemoglobin result from 2026-10-14 to 2026-11-13 meets the published definition's criteria for any category that counts (who2024_anaemia@1.0). Results: haemoglobin 134 g/L on 2026-10-22 09:00; haemoglobin 136 g/L on 2026-11-11 09:05.","sentence":"The note says “Anemia”, but no haemoglobin result from 2026-10-14 to 2026-11-13 meets the published definition's criteria for any category that counts (who2024_anaemia@1.0). Results: haemoglobin 134 g/L on 2026-10-22 09:00; haemoglobin 136 g/L on 2026-11-11 09:05.","threshold":"Categories that count (who2024_anaemia@1.0): 'severe' band (haemoglobin < 80 g/L); 'moderate' band (haemoglobin ≥ 80 g/L and haemoglobin < 110 g/L); 'mild' band (haemoglobin ≥ 110 g/L and haemoglobin < 130 g/L).","span":[197,203],"note_mentions":true,"lab_ids":["LM-P21-02"],"definition":"who2024_anaemia@1.0","version":"1.0","tier":"measured","values":"haemoglobin 134 g/L on 2026-10-22 09:00; haemoglobin 136 g/L on 2026-11-11 09:05","alternatives":[],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://iris.who.int/server/api/core/bitstreams/f9f74397-1440-478d-a63c-26f29a01552f/content","optional_set":null,"cite":{"id":"who2024_anaemia@1.0","title":"Guideline on haemoglobin cutoffs to define anaemia in individuals and populations","body":"World Health Organization","edition":"2024","year":2024,"url":"https://iris.who.int/server/api/core/bitstreams/f9f74397-1440-478d-a63c-26f29a01552f/content","locator":"Executive summary: Table 2 (PDF page 12), Table 3 (PDF page 13), Table 4 (PDF page 14), Table 5 (PDF page 15)","quote":"Table 3: Adults, 15–65 years, nonpregnant women: No anaemia ≥120; Mild 110–119; Moderate 80–109; Severe <80. Adults, 15–65, years men: ≥130; 110–129; 80–109; <80 (g/L)","accessed":"2026-11-14"}}],"more":[{"family":"potassium","topic":"Potassium","direction":"NONE","status":"agrees","label":"Agrees","icon":"✓","lead":"","quote":null,"text":"Potassium 5 mmol/L on 2026-11-11 09:05: in the category “below 5.5 mmol/L” of ukka2026_hyperkalaemia@1.0; the note doesn't mention this. Nothing to review.","sentence":"Potassium 5 mmol/L on 2026-11-11 09:05: in the category “below 5.5 mmol/L” of ukka2026_hyperkalaemia@1.0; the note doesn't mention this. Nothing to review.","threshold":"Categories that count (ukka2026_hyperkalaemia@1.0): 'severe' band (6.5 mmol/L or more) (potassium ≥ 6.5 mmol/L); 'moderate' band (6.0 to 6.4 mmol/L) (potassium ≥ 6 mmol/L and potassium < 6.5 mmol/L); 'mild' band (5.5 to 5.9 mmol/L) (potassium ≥ 5.5 mmol/L and potassium < 6 mmol/L).","span":null,"note_mentions":false,"lab_ids":["LM-P21-03"],"definition":"ukka2026_hyperkalaemia@1.0","version":"1.0","tier":"measured","values":"potassium 5 mmol/L on 2026-11-11 09:05","alternatives":[],"contested":true,"contested_text":"Published bodies disagree on these thresholds; another definition may give a different answer.","reviewed":false,"draft_label":"Draft definition: pending clinical and coding review","source_url":"https://www.ukkidney.org/sites/default/files/documents/FINAL%20VERSION%20-%20UKKA%20CLINICAL%20PRACTICE%20GUIDELINE%20-%20MANAGEMENT%20OF%20HYPERKALAEMIA%20IN%20ADULTS%20-%20UPDATED%20JULY%202026_0.pdf","optional_set":null,"cite":{"id":"ukka2026_hyperkalaemia@1.0","title":"Clinical Practice Guidelines: Treatment of Acute Hyperkalaemia in Adults","body":"UK Kidney Association","edition":"updated July 2026","year":2026,"url":"https://www.ukkidney.org/sites/default/files/documents/FINAL%20VERSION%20-%20UKKA%20CLINICAL%20PRACTICE%20GUIDELINE%20-%20MANAGEMENT%20OF%20HYPERKALAEMIA%20IN%20ADULTS%20-%20UPDATED%20JULY%202026_0.pdf","locator":"Introduction, document page 9 (PDF page 10)","quote":"It is further classified by severity into mild (5.5-5.9 mmol/l), moderate (6.0-6.4 mmol/l) or severe (≥ 6.5 mmol/l).","accessed":"2026-11-14"}}],"n_needs":1,"limit":3,"dismissed":0,"ctcae_on":false,"draft_label":"Draft definition: pending clinical and coding review","dismiss_reasons":{"addressed_elsewhere":"Already addressed elsewhere in the record","not_representative":"Values not representative (for example acute illness or a lab error)","not_relevant":"Not relevant to this visit","definition_not_applicable":"The definition does not apply to this patient","other":"Other (explain)"}},"findings":[{"family":"kidney","topic":"Kidney function over time","status":"not_assessable","label":"Not assessable","sentence":"Could not check kidney function: maintenance dialysis is on record, and the filtering-rate equation is not reliable then.","quote":null,"threshold":"Threshold: filtering rate below 60 on two results at least 90 days apart, none of 60 or more between them.","span":null,"note_mentions":false,"lab_ids":["L-0047","L-0048"]}]}