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Exact Dx synthetic data · demonstration

← All runs · Open P06

Replay RUN-00006

Live recomputation (nothing written): identical hash

Stored replay hash
9295148decb7336f1ee163b07ff60af90c4cb85901e90678440ff837fb029804
Recomputed replay hash
9295148decb7336f1ee163b07ff60af90c4cb85901e90678440ff837fb029804
Stored output sha256
6cf8a081eb24f18fcee3844334b8a764d752bc64a747a2421802bf85fa941bc0
Recomputed output sha256
6cf8a081eb24f18fcee3844334b8a764d752bc64a747a2421802bf85fa941bc0
Inputs intact
yes
Engine
kidney-engine 2.0
Trigger
seed · Fri Nov 13, 2026 04:55 PM · audit entry #1561
Rule versions used (bodies stored at first use; replay never reads today's files)
RuleVersionBody sha256Source
ckd_epi_20091.0fee2ce2be035c1b6…Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check)
ckd_epi_20211.02bc35edbf2f801a1…Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation)
kdigo_aki_20121.16927ab44b3d40429…KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2)
kdigo_ckd_20241.11a5087a17cd1b339…KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months)
kidney_compare1.123fd394b4f02789e…Two-sided comparison (this tool); ICD-10-CM guideline I.A.19; ACDIS/AHIMA compliant query practice, 2026 update
kidney_exclusions1.098e08ca8b6f5a7f7…KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list
kidney_staff1.0fb90888ec6577619…ICD-10-CM FY2026 guidelines I.A.15, I.C.9.a.2; CMS FY2026 Tables 6I/6J (staff view only)
lab_units1.1a53d26a712b0777f…KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g)

Replay history

Stored inputs (exactly what the rules read)
{
  "conditions": [],
  "encounter": {
    "admit_dt": "2026-11-11T10:00:00-05:00",
    "discharge_dt": "2026-11-11T10:40:00-05:00",
    "encounter_id": "KE-P06",
    "setting": "outpatient"
  },
  "labs": [
    {
      "collected_dt": "2026-06-14T09:00:00-04:00",
      "lab_id": "L-0012",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.3
    },
    {
      "collected_dt": "2026-11-11T08:30:00-05:00",
      "lab_id": "L-0013",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.4
    }
  ],
  "note_reading": {
    "aki": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "kidney": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "lexicon": "kidney-lexicon 1.0",
    "model_status": "ok",
    "reader": "lexicon+model"
  },
  "patient": {
    "birth_date": "1951-11-17",
    "patient_id": "P06",
    "sex": "F"
  },
  "statements": []
}
Stored output
{
  "aki": {
    "assessed": false,
    "clinician_text": "Not assessed: outpatient visit: the creatinine-change check runs on inpatient encounters only.",
    "criteria": [],
    "direction": "NOT_ASSESSED",
    "note_spans": 0,
    "note_status": "silent",
    "reason": "outpatient visit: the creatinine-change check runs on inpatient encounters only",
    "statement": null
  },
  "cdis": {
    "computed_code": "N18.32",
    "documented_code": null,
    "ladder": [
      {
        "code": "N18.9",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, unspecified",
        "level": "non-CC"
      },
      {
        "code": "N18.30",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, stage 3 unspecified",
        "level": "non-CC"
      },
      {
        "code": "N18.31",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, stage 3a",
        "level": "non-CC"
      },
      {
        "code": "N18.32",
        "computed": true,
        "documented": false,
        "label": "Chronic kidney disease, stage 3b",
        "level": "non-CC"
      },
      {
        "code": "N18.4",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, stage 4 (severe)",
        "level": "CC"
      },
      {
        "code": "N18.5",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, stage 5",
        "level": "CC"
      },
      {
        "code": "N18.6",
        "computed": false,
        "documented": false,
        "label": "End stage renal disease",
        "level": "MCC"
      }
    ],
    "linkage": []
  },
  "engine": "kidney-engine 2.0",
  "findings": [
    {
      "cdis_text": "UNDER: nothing documented; computed G3b -> N18.32 (2021 equation); criteria met under 2 of 2 eGFR equations (2021 race-free, 2009).",
      "clinician_text": "eGFR 39.5 on 2026-11-11 (lab row L-0013) and eGFR 43.1 on 2026-06-14 (lab row L-0012), 150 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (the range both values meet). Note: no kidney-function statement found.",
      "direction": "UNDER",
      "family": "kidney",
      "robustness": "criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)"
    },
    {
      "cdis_text": "NOT_ASSESSED: outpatient visit: the creatinine-change check runs on inpatient encounters only.",
      "clinician_text": "Not assessed: outpatient visit: the creatinine-change check runs on inpatient encounters only.",
      "direction": "NOT_ASSESSED",
      "family": "aki",
      "robustness": "outpatient visit: the creatinine-change check runs on inpatient encounters only"
    }
  ],
  "kidney": {
    "acr": [],
    "acute_change": {
      "flag": false,
      "latest": "L-0013",
      "latest_value": 1.4,
      "lookback_days": 365,
      "lowest": "L-0012",
      "lowest_value": 1.3,
      "ratio": 1.08
    },
    "albuminuria": {
      "days_apart": null,
      "latest": null,
      "met": false,
      "pair": null,
      "pair_values": null,
      "persistent_value": null,
      "reason": "no qualifying value"
    },
    "by_equation": {
      "2009": {
        "direction": "UNDER",
        "direction_why": "",
        "latest": {
          "confirmed": true,
          "date": "2026-11-11",
          "g": "G3b",
          "lab_id": "L-0013",
          "value": 36.9
        },
        "met": true,
        "persistence": {
          "days_apart": 150,
          "latest": "L-0013",
          "latest_value": 36.9,
          "met": true,
          "pair": [
            "L-0012",
            "L-0013"
          ],
          "pair_dates": [
            "2026-06-14",
            "2026-11-11"
          ],
          "pair_values": [
            40.4,
            36.9
          ],
          "persistent_value": 40.4,
          "reason": "met"
        },
        "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
        "reason_code": "met",
        "route": "egfr",
        "stage": "G3b",
        "status": "met"
      },
      "2021": {
        "direction": "UNDER",
        "direction_why": "",
        "latest": {
          "confirmed": true,
          "date": "2026-11-11",
          "g": "G3b",
          "lab_id": "L-0013",
          "value": 39.5
        },
        "met": true,
        "persistence": {
          "days_apart": 150,
          "latest": "L-0013",
          "latest_value": 39.5,
          "met": true,
          "pair": [
            "L-0012",
            "L-0013"
          ],
          "pair_dates": [
            "2026-06-14",
            "2026-11-11"
          ],
          "pair_values": [
            43.1,
            39.5
          ],
          "persistent_value": 43.1,
          "reason": "met"
        },
        "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
        "reason_code": "met",
        "route": "egfr",
        "stage": "G3b",
        "status": "met"
      }
    },
    "clinician_text": "eGFR 39.5 on 2026-11-11 (lab row L-0013) and eGFR 43.1 on 2026-06-14 (lab row L-0012), 150 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (the range both values meet). Note: no kidney-function statement found.",
    "criteria": [
      {
        "criterion_key": "no_exclusion_on_record",
        "detail": "none on record for this encounter date",
        "inputs": {
          "condition_ids": [],
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "label": "No condition on record that makes the estimating equation unreliable (maintenance dialysis, kidney transplant, pregnancy, limb amputation or another extreme of muscle mass)",
        "passed": true,
        "rule_id": "kidney_exclusions"
      },
      {
        "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2021",
        "detail": "pair L-0012 (43.1, 2026-06-14) and L-0013 (39.5, 2026-11-11), 150 days apart; persistent category G3b (the range both values meet)",
        "inputs": {
          "dates": [
            "2026-06-14",
            "2026-11-11"
          ],
          "lab_ids": [
            "L-0012",
            "L-0013"
          ],
          "values": [
            43.1,
            39.5
          ]
        },
        "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation)",
        "passed": true,
        "rule_id": "kdigo_ckd_2024"
      },
      {
        "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2009",
        "detail": "pair L-0012 (40.4, 2026-06-14) and L-0013 (36.9, 2026-11-11), 150 days apart; persistent category G3b (the range both values meet)",
        "inputs": {
          "dates": [
            "2026-06-14",
            "2026-11-11"
          ],
          "lab_ids": [
            "L-0012",
            "L-0013"
          ],
          "values": [
            40.4,
            36.9
          ]
        },
        "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation)",
        "passed": true,
        "rule_id": "kdigo_ckd_2024"
      },
      {
        "criterion_key": "albuminuria_a2_a3_persistent",
        "detail": "no urine ACR on file",
        "inputs": {
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "label": "Urine ACR >= 30 mg/g on two values at least 90 days apart (needed only when eGFR >= 60)",
        "passed": false,
        "rule_id": "kdigo_ckd_2024"
      },
      {
        "criterion_key": "steady_state_values",
        "detail": "no values excluded",
        "inputs": {
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "label": "Values used are steady-state (local convention: values from an admission meeting the creatinine-change criteria are excluded)",
        "passed": true,
        "rule_id": "kdigo_ckd_2024"
      },
      {
        "criterion_key": "latest_lt_1_5x_prior_lowest",
        "detail": "1.4 / 1.3 = 1.08x",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0012",
            "L-0013"
          ],
          "values": [
            1.3,
            1.4
          ]
        },
        "label": "Latest creatinine below 1.5x the lowest value in the previous 365 days (otherwise: possible acute change; repeat needed)",
        "passed": true,
        "rule_id": "kdigo_ckd_2024"
      }
    ],
    "direction": "UNDER",
    "direction_why": "",
    "drift": false,
    "egfr": [
      {
        "age": 74,
        "collected_dt": "2026-06-14T09:00:00-04:00",
        "date": "2026-06-14",
        "egfr_2009": 40.4,
        "egfr_2021": 43.1,
        "excluded": null,
        "g_2009": "G3b",
        "g_2021": "G3b",
        "lab_id": "L-0012",
        "scr": 1.3
      },
      {
        "age": 74,
        "collected_dt": "2026-11-11T08:30:00-05:00",
        "date": "2026-11-11",
        "egfr_2009": 36.9,
        "egfr_2021": 39.5,
        "excluded": null,
        "g_2009": "G3b",
        "g_2021": "G3b",
        "lab_id": "L-0013",
        "scr": 1.4
      }
    ],
    "exclusions": [],
    "note_spans": 0,
    "note_status": "silent",
    "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
    "robustness": "criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)",
    "stated_stage": null,
    "statement": null,
    "status": "met"
  },
  "measurement": {
    "aki": {
      "assessed": false,
      "criteria": [],
      "reason": "outpatient visit: the creatinine-change check runs on inpatient encounters only",
      "text": "Not assessed: outpatient visit: the creatinine-change check runs on inpatient encounters only."
    },
    "data_notes": [],
    "engine": "kidney-engine 2.0",
    "kidney": {
      "acr": [],
      "acute_change": {
        "flag": false,
        "latest": "L-0013",
        "latest_value": 1.4,
        "lookback_days": 365,
        "lowest": "L-0012",
        "lowest_value": 1.3,
        "ratio": 1.08
      },
      "albuminuria": {
        "days_apart": null,
        "latest": null,
        "met": false,
        "pair": null,
        "pair_values": null,
        "persistent_value": null,
        "reason": "no qualifying value"
      },
      "by_equation": {
        "2009": {
          "latest": {
            "confirmed": true,
            "date": "2026-11-11",
            "g": "G3b",
            "lab_id": "L-0013",
            "value": 36.9
          },
          "met": true,
          "persistence": {
            "days_apart": 150,
            "latest": "L-0013",
            "latest_value": 36.9,
            "met": true,
            "pair": [
              "L-0012",
              "L-0013"
            ],
            "pair_dates": [
              "2026-06-14",
              "2026-11-11"
            ],
            "pair_values": [
              40.4,
              36.9
            ],
            "persistent_value": 40.4,
            "reason": "met"
          },
          "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
          "reason_code": "met",
          "route": "egfr",
          "stage": "G3b",
          "status": "met"
        },
        "2021": {
          "latest": {
            "confirmed": true,
            "date": "2026-11-11",
            "g": "G3b",
            "lab_id": "L-0013",
            "value": 39.5
          },
          "met": true,
          "persistence": {
            "days_apart": 150,
            "latest": "L-0013",
            "latest_value": 39.5,
            "met": true,
            "pair": [
              "L-0012",
              "L-0013"
            ],
            "pair_dates": [
              "2026-06-14",
              "2026-11-11"
            ],
            "pair_values": [
              43.1,
              39.5
            ],
            "persistent_value": 43.1,
            "reason": "met"
          },
          "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
          "reason_code": "met",
          "route": "egfr",
          "stage": "G3b",
          "status": "met"
        }
      },
      "criteria": [
        {
          "criterion_key": "no_exclusion_on_record",
          "detail": "none on record for this encounter date",
          "inputs": {
            "condition_ids": [],
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "label": "No condition on record that makes the estimating equation unreliable (maintenance dialysis, kidney transplant, pregnancy, limb amputation or another extreme of muscle mass)",
          "passed": true,
          "rule_id": "kidney_exclusions"
        },
        {
          "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2021",
          "detail": "pair L-0012 (43.1, 2026-06-14) and L-0013 (39.5, 2026-11-11), 150 days apart; persistent category G3b (the range both values meet)",
          "inputs": {
            "dates": [
              "2026-06-14",
              "2026-11-11"
            ],
            "lab_ids": [
              "L-0012",
              "L-0013"
            ],
            "values": [
              43.1,
              39.5
            ]
          },
          "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation)",
          "passed": true,
          "rule_id": "kdigo_ckd_2024"
        },
        {
          "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2009",
          "detail": "pair L-0012 (40.4, 2026-06-14) and L-0013 (36.9, 2026-11-11), 150 days apart; persistent category G3b (the range both values meet)",
          "inputs": {
            "dates": [
              "2026-06-14",
              "2026-11-11"
            ],
            "lab_ids": [
              "L-0012",
              "L-0013"
            ],
            "values": [
              40.4,
              36.9
            ]
          },
          "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation)",
          "passed": true,
          "rule_id": "kdigo_ckd_2024"
        },
        {
          "criterion_key": "albuminuria_a2_a3_persistent",
          "detail": "no urine ACR on file",
          "inputs": {
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "label": "Urine ACR >= 30 mg/g on two values at least 90 days apart (needed only when eGFR >= 60)",
          "passed": false,
          "rule_id": "kdigo_ckd_2024"
        },
        {
          "criterion_key": "steady_state_values",
          "detail": "no values excluded",
          "inputs": {
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "label": "Values used are steady-state (local convention: values from an admission meeting the creatinine-change criteria are excluded)",
          "passed": true,
          "rule_id": "kdigo_ckd_2024"
        },
        {
          "criterion_key": "latest_lt_1_5x_prior_lowest",
          "detail": "1.4 / 1.3 = 1.08x",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0012",
              "L-0013"
            ],
            "values": [
              1.3,
              1.4
            ]
          },
          "label": "Latest creatinine below 1.5x the lowest value in the previous 365 days (otherwise: possible acute change; repeat needed)",
          "passed": true,
          "rule_id": "kdigo_ckd_2024"
        }
      ],
      "drift": false,
      "egfr": [
        {
          "age": 74,
          "collected_dt": "2026-06-14T09:00:00-04:00",
          "date": "2026-06-14",
          "egfr_2009": 40.4,
          "egfr_2021": 43.1,
          "excluded": null,
          "g_2009": "G3b",
          "g_2021": "G3b",
          "lab_id": "L-0012",
          "scr": 1.3
        },
        {
          "age": 74,
          "collected_dt": "2026-11-11T08:30:00-05:00",
          "date": "2026-11-11",
          "egfr_2009": 36.9,
          "egfr_2021": 39.5,
          "excluded": null,
          "g_2009": "G3b",
          "g_2021": "G3b",
          "lab_id": "L-0013",
          "scr": 1.4
        }
      ],
      "exclusions": [],
      "reason": "two values below 60 at least 90 days apart, none of 60 or more between",
      "robustness": "criteria met under 2 of 2 eGFR equations (2021 race-free, 2009)",
      "status": "met",
      "text": "eGFR 39.5 on 2026-11-11 (lab row L-0013) and eGFR 43.1 on 2026-06-14 (lab row L-0012), 150 days apart, no value >= 60 between. KDIGO persistence: met. Persistent GFR category G3b (the range both values meet)."
    },
    "rules": {
      "ckd_epi_2009": {
        "body_sha256": "fee2ce2be035c1b64d4404d5f2e9cfa8cdd37c98dac9d20c4148c9d2c45560d5",
        "version": "1.0"
      },
      "ckd_epi_2021": {
        "body_sha256": "2bc35edbf2f801a13194a537bb67b28d8c3b0175462b716b9f23c6c51f581517",
        "version": "1.0"
      },
      "kdigo_aki_2012": {
        "body_sha256": "6927ab44b3d4042994ba6f31a985cbae46ff27734c13546c8469110473baec49",
        "version": "1.1"
      },
      "kdigo_ckd_2024": {
        "body_sha256": "1a5087a17cd1b339f06da694dd8fcb92fe2f13fdbce57b886716763289bd95ad",
        "version": "1.1"
      },
      "kidney_exclusions": {
        "body_sha256": "98e08ca8b6f5a7f7a68b225b57239006b4664aa533200feaca96e84c0430217b",
        "version": "1.0"
      },
      "lab_units": {
        "body_sha256": "a53d26a712b0777f23b4b72dff9d65a8567ca57dadd924bc1ecf0cebc9ac2b18",
        "version": "1.1"
      }
    }
  },
  "measurement_sha256": "bb4bccbb949302893d1860034f5fdb9d1cd85e0f1f28085f1f67a3d111b85b33",
  "note_reading": {
    "aki": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "kidney": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "lexicon": "kidney-lexicon 1.0",
    "model_status": "ok",
    "reader": "lexicon+model"
  },
  "rules": {
    "ckd_epi_2009": {
      "body_sha256": "fee2ce2be035c1b64d4404d5f2e9cfa8cdd37c98dac9d20c4148c9d2c45560d5",
      "version": "1.0"
    },
    "ckd_epi_2021": {
      "body_sha256": "2bc35edbf2f801a13194a537bb67b28d8c3b0175462b716b9f23c6c51f581517",
      "version": "1.0"
    },
    "kdigo_aki_2012": {
      "body_sha256": "6927ab44b3d4042994ba6f31a985cbae46ff27734c13546c8469110473baec49",
      "version": "1.1"
    },
    "kdigo_ckd_2024": {
      "body_sha256": "1a5087a17cd1b339f06da694dd8fcb92fe2f13fdbce57b886716763289bd95ad",
      "version": "1.1"
    },
    "kidney_compare": {
      "body_sha256": "23fd394b4f02789eec020368dcfc30acab0cb62e411c3f4651d2bc778e3ee6cf",
      "version": "1.1"
    },
    "kidney_exclusions": {
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