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Exact Dx synthetic data · demonstration

← All runs · Open P09

Replay RUN-00009

Live recomputation (nothing written): identical hash

Stored replay hash
1b1921695ee7c7fc26f99962bd161dbe9a2e805e9e6757d2c452a9b2bf1dc941
Recomputed replay hash
1b1921695ee7c7fc26f99962bd161dbe9a2e805e9e6757d2c452a9b2bf1dc941
Stored output sha256
658a4e30b657e325a9e6e9787296a2839ccdd3ccb605048c8bf36e73c47d4cdf
Recomputed output sha256
658a4e30b657e325a9e6e9787296a2839ccdd3ccb605048c8bf36e73c47d4cdf
Inputs intact
yes
Engine
kidney-engine 2.0
Trigger
seed · Fri Nov 13, 2026 04:55 PM · audit entry #1573
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": "2026-11-11T15:00:00-05:00",
    "discharge_dt": "2026-11-11T15:40:00-05:00",
    "encounter_id": "KE-P09",
    "setting": "outpatient"
  },
  "labs": [
    {
      "collected_dt": "2026-11-11T14:00:00-05:00",
      "lab_id": "L-0018",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.5
    }
  ],
  "note_reading": {
    "aki": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "kidney": {
      "faults": [],
      "spans": [
        {
          "assertion": "affirmed",
          "end": 154,
          "kind": "chronic",
          "origin": "both",
          "stage": "3",
          "start": 149
        }
      ],
      "status": "stated"
    },
    "lexicon": "kidney-lexicon 1.0",
    "model_status": "ok",
    "reader": "lexicon+model"
  },
  "patient": {
    "birth_date": "1967-11-17",
    "patient_id": "P09",
    "sex": "M"
  },
  "statements": [
    {
      "dx_id": "KD-KN-P09-1-S01",
      "icd10": "N18.30",
      "note_id": "KN-P09-1",
      "quoted_text": "CKD 3",
      "source": "note_extraction",
      "span_end": 154,
      "span_start": 149
    }
  ]
}
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": null,
    "documented_code": "N18.30",
    "ladder": [
      {
        "code": "N18.9",
        "computed": false,
        "documented": false,
        "label": "Chronic kidney disease, unspecified",
        "level": "non-CC"
      },
      {
        "code": "N18.30",
        "computed": false,
        "documented": true,
        "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": false,
        "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": "NOT_ASSESSABLE: documented N18.30; one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later.",
      "clinician_text": "eGFR 53.6 on 2026-11-11 (lab row L-0018). Not assessable: one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later. Lookback: every creatinine result on file before this note. Note: a kidney-function statement is present (quoted below); it cannot be checked against these values.",
      "direction": "NOT_ASSESSABLE",
      "family": "kidney",
      "robustness": "not assessable"
    },
    {
      "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": null,
      "lowest": null,
      "ratio": null
    },
    "albuminuria": {
      "days_apart": null,
      "latest": null,
      "met": false,
      "pair": null,
      "pair_values": null,
      "persistent_value": null,
      "reason": "no qualifying value"
    },
    "by_equation": {
      "2009": {
        "direction": "NOT_ASSESSABLE",
        "direction_why": "one value below 60 (eGFR 50.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "latest": {
          "confirmed": true,
          "date": "2026-11-11",
          "g": "G3a",
          "lab_id": "L-0018",
          "value": 50.6
        },
        "met": false,
        "persistence": {
          "days_apart": null,
          "latest": null,
          "met": false,
          "pair": null,
          "pair_values": null,
          "persistent_value": null,
          "reason": "single value, persistence not established"
        },
        "reason": "one value below 60 (eGFR 50.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "reason_code": "single_low",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      },
      "2021": {
        "direction": "NOT_ASSESSABLE",
        "direction_why": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "latest": {
          "confirmed": true,
          "date": "2026-11-11",
          "g": "G3a",
          "lab_id": "L-0018",
          "value": 53.6
        },
        "met": false,
        "persistence": {
          "days_apart": null,
          "latest": null,
          "met": false,
          "pair": null,
          "pair_values": null,
          "persistent_value": null,
          "reason": "single value, persistence not established"
        },
        "reason": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "reason_code": "single_low",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      }
    },
    "clinician_text": "eGFR 53.6 on 2026-11-11 (lab row L-0018). Not assessable: one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later. Lookback: every creatinine result on file before this note. Note: a kidney-function statement is present (quoted below); it cannot be checked against these values.",
    "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": "not assessable: one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "inputs": {
          "dates": [
            "2026-11-11"
          ],
          "lab_ids": [
            "L-0018"
          ],
          "values": [
            53.6
          ]
        },
        "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation)",
        "passed": false,
        "rule_id": "kdigo_ckd_2024"
      },
      {
        "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2009",
        "detail": "not assessable: one value below 60 (eGFR 50.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
        "inputs": {
          "dates": [
            "2026-11-11"
          ],
          "lab_ids": [
            "L-0018"
          ],
          "values": [
            50.6
          ]
        },
        "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation)",
        "passed": false,
        "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"
      }
    ],
    "direction": "NOT_ASSESSABLE",
    "direction_why": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
    "drift": false,
    "egfr": [
      {
        "age": 58,
        "collected_dt": "2026-11-11T14:00:00-05:00",
        "date": "2026-11-11",
        "egfr_2009": 50.6,
        "egfr_2021": 53.6,
        "excluded": null,
        "g_2009": "G3a",
        "g_2021": "G3a",
        "lab_id": "L-0018",
        "scr": 1.5
      }
    ],
    "exclusions": [],
    "note_spans": 1,
    "note_status": "stated",
    "reason": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
    "robustness": "not assessable",
    "stated_stage": "G3",
    "statement": {
      "dx_id": "KD-KN-P09-1-S01",
      "icd10": "N18.30",
      "note_id": "KN-P09-1",
      "quoted_text": "CKD 3",
      "source": "note_extraction",
      "span_end": 154,
      "span_start": 149
    },
    "status": "not_assessable"
  },
  "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": null,
        "lowest": null,
        "ratio": null
      },
      "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": "G3a",
            "lab_id": "L-0018",
            "value": 50.6
          },
          "met": false,
          "persistence": {
            "days_apart": null,
            "latest": null,
            "met": false,
            "pair": null,
            "pair_values": null,
            "persistent_value": null,
            "reason": "single value, persistence not established"
          },
          "reason": "one value below 60 (eGFR 50.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
          "reason_code": "single_low",
          "route": null,
          "stage": null,
          "status": "not_assessable"
        },
        "2021": {
          "latest": {
            "confirmed": true,
            "date": "2026-11-11",
            "g": "G3a",
            "lab_id": "L-0018",
            "value": 53.6
          },
          "met": false,
          "persistence": {
            "days_apart": null,
            "latest": null,
            "met": false,
            "pair": null,
            "pair_values": null,
            "persistent_value": null,
            "reason": "single value, persistence not established"
          },
          "reason": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
          "reason_code": "single_low",
          "route": null,
          "stage": null,
          "status": "not_assessable"
        }
      },
      "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": "not assessable: one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
          "inputs": {
            "dates": [
              "2026-11-11"
            ],
            "lab_ids": [
              "L-0018"
            ],
            "values": [
              53.6
            ]
          },
          "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2021 eGFR equation)",
          "passed": false,
          "rule_id": "kdigo_ckd_2024"
        },
        {
          "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2009",
          "detail": "not assessable: one value below 60 (eGFR 50.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
          "inputs": {
            "dates": [
              "2026-11-11"
            ],
            "lab_ids": [
              "L-0018"
            ],
            "values": [
              50.6
            ]
          },
          "label": "Two eGFR < 60 at least 90 days apart, none >= 60 between (2009 eGFR equation)",
          "passed": false,
          "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"
        }
      ],
      "drift": false,
      "egfr": [
        {
          "age": 58,
          "collected_dt": "2026-11-11T14:00:00-05:00",
          "date": "2026-11-11",
          "egfr_2009": 50.6,
          "egfr_2021": 53.6,
          "excluded": null,
          "g_2009": "G3a",
          "g_2021": "G3a",
          "lab_id": "L-0018",
          "scr": 1.5
        }
      ],
      "exclusions": [],
      "reason": "one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later",
      "robustness": "not assessable",
      "status": "not_assessable",
      "text": "eGFR 53.6 on 2026-11-11 (lab row L-0018). Not assessable: one value below 60 (eGFR 53.6 on 2026-11-11); persistence needs a repeat at least 90 days later. Lookback: every creatinine result on file before this note."
    },
    "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": "ef524885281e9bb38b2f18791fd177c3717d323e3b0ea4741f5636b2cf477eae",
  "note_reading": {
    "aki": {
      "faults": [],
      "spans": [],
      "status": "silent"
    },
    "kidney": {
      "faults": [],
      "spans": [
        {
          "assertion": "affirmed",
          "end": 154,
          "kind": "chronic",
          "origin": "both",
          "stage": "3",
          "start": 149
        }
      ],
      "status": "stated"
    },
    "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": {
      "body_sha256": "98e08ca8b6f5a7f7a68b225b57239006b4664aa533200feaca96e84c0430217b",
      "version": "1.0"
    },
    "kidney_staff": {
      "body_sha256": "fb90888ec65776194e9b5fd58c973b451f4072b64dc12409453c6cd4a8042281",
      "version": "1.0"
    },
    "lab_units": {
      "body_sha256": "a53d26a712b0777f23b4b72dff9d65a8567ca57dadd924bc1ecf0cebc9ac2b18",
      "version": "1.1"
    }
  }
}