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Exact Dx synthetic data · demonstration

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Replay RUN-00015

Live recomputation (nothing written): identical hash

Stored replay hash
8f35978ee48431945b7216c52e6074cb8bc84623f683ae610db23438b907c588
Recomputed replay hash
8f35978ee48431945b7216c52e6074cb8bc84623f683ae610db23438b907c588
Stored output sha256
f7a097f374ed0cdfdb3af386f0c7be28af1ecb6aef9fb4efbb23855a339aa612
Recomputed output sha256
f7a097f374ed0cdfdb3af386f0c7be28af1ecb6aef9fb4efbb23855a339aa612
Inputs intact
yes
Engine
kidney-engine 2.0
Trigger
seed · Fri Nov 13, 2026 04:55 PM · audit entry #1597
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": "2026-11-11T14:00:00-05:00",
    "discharge_dt": null,
    "encounter_id": "KE-P15",
    "setting": "inpatient"
  },
  "labs": [
    {
      "collected_dt": "2026-11-11T15:00:00-05:00",
      "lab_id": "L-0033",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.2
    },
    {
      "collected_dt": "2026-11-12T15:00:00-05:00",
      "lab_id": "L-0034",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.6
    }
  ],
  "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": "1950-11-16",
    "patient_id": "P15",
    "sex": "F"
  },
  "statements": []
}
Stored output
{
  "aki": {
    "abs_rise": [
      {
        "from": "L-0033",
        "hours": 24.0,
        "rise": 0.4,
        "to": "L-0034"
      }
    ],
    "admission": {
      "collected_dt": "2026-11-11T15:00:00-05:00",
      "lab_id": "L-0033",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.2
    },
    "assessable": true,
    "assessed": true,
    "baselines": {
      "back_calculated": {
        "available": true,
        "detail": "eGFR 75 at age 75, sex F",
        "lab_ids": [],
        "label": "Back-calculated from eGFR 75 (2021 equation, age and sex at admission)",
        "value": 0.816
      },
      "last_outpatient": {
        "available": false,
        "lab_ids": [],
        "label": "Most recent outpatient value 7-365 days before admission",
        "value": null
      },
      "lowest_365": {
        "available": false,
        "lab_ids": [],
        "label": "Lowest value in the 365 days before admission",
        "value": null
      },
      "median_365": {
        "available": false,
        "lab_ids": [],
        "label": "Median of values in the 365 days before admission",
        "value": null
      }
    },
    "clinician_text": "Creatinine 1.2 mg/dL at admission (lab row L-0033), peak 1.6 mg/dL (lab row L-0034). KDIGO creatinine criterion met: criteria met under 0 of 4 baselines at admission; 4 of 4 at peak. Urine-output criterion not evaluated (no structured source). Note: no statement about an acute kidney change 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 creatinine-change criteria unreliable (maintenance dialysis, kidney transplant, pregnancy)",
        "passed": true,
        "rule_id": "kidney_exclusions"
      },
      {
        "criterion_key": "pre_admission_baseline_available",
        "detail": "none in the 365 days before admission",
        "inputs": {
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "label": "A creatinine value before admission is available (needed before a statement can be called not supported)",
        "passed": false,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "abs_rise_0_3_in_48h",
        "detail": "L-0033 -> L-0034: +0.4 mg/dL in 24.0 h",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            0.4
          ]
        },
        "label": "Creatinine rise >= 0.3 mg/dL within 48 hours",
        "passed": true,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "ratio_ge_1_5x_lowest_365",
        "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            null,
            1.2,
            1.6
          ]
        },
        "label": "Creatinine >= 1.5x baseline (lowest value in the 365 days before admission)",
        "passed": true,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "ratio_ge_1_5x_last_outpatient",
        "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            null,
            1.2,
            1.6
          ]
        },
        "label": "Creatinine >= 1.5x baseline (most recent outpatient value 7-365 days before admission)",
        "passed": true,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "ratio_ge_1_5x_median_365",
        "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            null,
            1.2,
            1.6
          ]
        },
        "label": "Creatinine >= 1.5x baseline (median of values in the 365 days before admission)",
        "passed": true,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "ratio_ge_1_5x_back_calculated",
        "detail": "baseline 0.816 mg/dL; admission stage 0, peak stage 1 (never used alone)",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            0.816,
            1.2,
            1.6
          ]
        },
        "label": "Creatinine >= 1.5x baseline (back-calculated from egfr 75 (2021 equation, age and sex at admission))",
        "passed": true,
        "rule_id": "kdigo_aki_2012"
      },
      {
        "criterion_key": "reverse_ge_1_5x_later_nadir",
        "detail": "L-0033 1.2 mg/dL vs L-0034 1.6 mg/dL: 0.75x",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "values": [
            1.2,
            1.6
          ]
        },
        "label": "Reverse comparison: admission or peak creatinine >= 1.5x the lowest value in the following 7 days",
        "passed": false,
        "rule_id": "kdigo_aki_2012"
      }
    ],
    "direction": "UNDER",
    "episode_lab_ids": [
      "L-0033",
      "L-0034"
    ],
    "exclusions": [],
    "k_admission": 0,
    "k_peak": 4,
    "n_baselines": 4,
    "note_spans": 0,
    "note_status": "silent",
    "peak": {
      "collected_dt": "2026-11-12T15:00:00-05:00",
      "lab_id": "L-0034",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.6
    },
    "per_baseline": {
      "back_calculated": {
        "admission": {
          "met": false,
          "ratio": 1.47,
          "stage": 0
        },
        "peak": {
          "lab_id": "L-0034",
          "met": true,
          "ratio": 1.96,
          "stage": 1
        }
      },
      "last_outpatient": {
        "admission": {
          "met": false,
          "ratio": null,
          "stage": 0
        },
        "peak": {
          "lab_id": "L-0034",
          "met": true,
          "ratio": null,
          "stage": 1
        }
      },
      "lowest_365": {
        "admission": {
          "met": false,
          "ratio": null,
          "stage": 0
        },
        "peak": {
          "lab_id": "L-0034",
          "met": true,
          "ratio": null,
          "stage": 1
        }
      },
      "median_365": {
        "admission": {
          "met": false,
          "ratio": null,
          "stage": 0
        },
        "peak": {
          "lab_id": "L-0034",
          "met": true,
          "ratio": null,
          "stage": 1
        }
      }
    },
    "pre_admission_baseline": false,
    "reason": "",
    "reason_code": null,
    "reverse": {
      "days": 7,
      "from": "L-0033",
      "from_value": 1.2,
      "met": false,
      "ratio": 0.75,
      "to": "L-0034",
      "to_value": 1.6
    },
    "robustness": "criteria met under 0 of 4 baselines at admission; 4 of 4 at peak",
    "statement": null
  },
  "cdis": {
    "computed_code": null,
    "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": 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: nothing documented; no steady-state creatinine result on file.",
      "clinician_text": "no steady-state creatinine on file. Not assessable: no steady-state creatinine result on file. Lookback: every creatinine result on file before this note. Nothing to review until the data can decide.",
      "direction": "NOT_ASSESSABLE",
      "family": "kidney",
      "robustness": "not assessable"
    },
    {
      "cdis_text": "UNDER: nothing documented; N17.9 ladder applies only if the clinician documents it; criteria met under 0 of 4 baselines at admission; 4 of 4 at peak.",
      "clinician_text": "Creatinine 1.2 mg/dL at admission (lab row L-0033), peak 1.6 mg/dL (lab row L-0034). KDIGO creatinine criterion met: criteria met under 0 of 4 baselines at admission; 4 of 4 at peak. Urine-output criterion not evaluated (no structured source). Note: no statement about an acute kidney change found.",
      "direction": "UNDER",
      "family": "aki",
      "robustness": "criteria met under 0 of 4 baselines at admission; 4 of 4 at peak"
    }
  ],
  "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": "no steady-state creatinine result on file",
        "latest": null,
        "met": false,
        "persistence": {
          "days_apart": null,
          "latest": null,
          "met": false,
          "pair": null,
          "pair_values": null,
          "persistent_value": null,
          "reason": "no qualifying value"
        },
        "reason": "no steady-state creatinine result on file",
        "reason_code": "no_values",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      },
      "2021": {
        "direction": "NOT_ASSESSABLE",
        "direction_why": "no steady-state creatinine result on file",
        "latest": null,
        "met": false,
        "persistence": {
          "days_apart": null,
          "latest": null,
          "met": false,
          "pair": null,
          "pair_values": null,
          "persistent_value": null,
          "reason": "no qualifying value"
        },
        "reason": "no steady-state creatinine result on file",
        "reason_code": "no_values",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      }
    },
    "clinician_text": "no steady-state creatinine on file. Not assessable: no steady-state creatinine result on file. Lookback: every creatinine result on file before this note. Nothing to review until the data can decide.",
    "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: no steady-state creatinine result on file",
        "inputs": {
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "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: no steady-state creatinine result on file",
        "inputs": {
          "dates": [],
          "lab_ids": [],
          "values": []
        },
        "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": "excluded L-0033, L-0034",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0033",
            "L-0034"
          ],
          "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": "no steady-state creatinine result on file",
    "drift": false,
    "egfr": [
      {
        "age": 75,
        "collected_dt": "2026-11-11T15:00:00-05:00",
        "date": "2026-11-11",
        "egfr_2009": 44.2,
        "egfr_2021": 47.2,
        "excluded": "collected during an admission in which the creatinine-change criteria are met (not steady state)",
        "g_2009": "G3b",
        "g_2021": "G3a",
        "lab_id": "L-0033",
        "scr": 1.2
      },
      {
        "age": 75,
        "collected_dt": "2026-11-12T15:00:00-05:00",
        "date": "2026-11-12",
        "egfr_2009": 31.2,
        "egfr_2021": 33.4,
        "excluded": "collected during an admission in which the creatinine-change criteria are met (not steady state)",
        "g_2009": "G3b",
        "g_2021": "G3b",
        "lab_id": "L-0034",
        "scr": 1.6
      }
    ],
    "exclusions": [],
    "note_spans": 0,
    "note_status": "silent",
    "reason": "no steady-state creatinine result on file",
    "robustness": "not assessable",
    "stated_stage": null,
    "statement": null,
    "status": "not_assessable"
  },
  "measurement": {
    "aki": {
      "abs_rise": [
        {
          "from": "L-0033",
          "hours": 24.0,
          "rise": 0.4,
          "to": "L-0034"
        }
      ],
      "admission": {
        "collected_dt": "2026-11-11T15:00:00-05:00",
        "lab_id": "L-0033",
        "loinc": "2160-0",
        "unit": "mg/dL",
        "value": 1.2
      },
      "assessable": true,
      "assessed": true,
      "baselines": {
        "back_calculated": {
          "available": true,
          "detail": "eGFR 75 at age 75, sex F",
          "lab_ids": [],
          "label": "Back-calculated from eGFR 75 (2021 equation, age and sex at admission)",
          "value": 0.816
        },
        "last_outpatient": {
          "available": false,
          "lab_ids": [],
          "label": "Most recent outpatient value 7-365 days before admission",
          "value": null
        },
        "lowest_365": {
          "available": false,
          "lab_ids": [],
          "label": "Lowest value in the 365 days before admission",
          "value": null
        },
        "median_365": {
          "available": false,
          "lab_ids": [],
          "label": "Median of values in the 365 days before admission",
          "value": null
        }
      },
      "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 creatinine-change criteria unreliable (maintenance dialysis, kidney transplant, pregnancy)",
          "passed": true,
          "rule_id": "kidney_exclusions"
        },
        {
          "criterion_key": "pre_admission_baseline_available",
          "detail": "none in the 365 days before admission",
          "inputs": {
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "label": "A creatinine value before admission is available (needed before a statement can be called not supported)",
          "passed": false,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "abs_rise_0_3_in_48h",
          "detail": "L-0033 -> L-0034: +0.4 mg/dL in 24.0 h",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              0.4
            ]
          },
          "label": "Creatinine rise >= 0.3 mg/dL within 48 hours",
          "passed": true,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "ratio_ge_1_5x_lowest_365",
          "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              null,
              1.2,
              1.6
            ]
          },
          "label": "Creatinine >= 1.5x baseline (lowest value in the 365 days before admission)",
          "passed": true,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "ratio_ge_1_5x_last_outpatient",
          "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              null,
              1.2,
              1.6
            ]
          },
          "label": "Creatinine >= 1.5x baseline (most recent outpatient value 7-365 days before admission)",
          "passed": true,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "ratio_ge_1_5x_median_365",
          "detail": "baseline not available; peak stage 1 from the 48-hour rise only",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              null,
              1.2,
              1.6
            ]
          },
          "label": "Creatinine >= 1.5x baseline (median of values in the 365 days before admission)",
          "passed": true,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "ratio_ge_1_5x_back_calculated",
          "detail": "baseline 0.816 mg/dL; admission stage 0, peak stage 1 (never used alone)",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              0.816,
              1.2,
              1.6
            ]
          },
          "label": "Creatinine >= 1.5x baseline (back-calculated from egfr 75 (2021 equation, age and sex at admission))",
          "passed": true,
          "rule_id": "kdigo_aki_2012"
        },
        {
          "criterion_key": "reverse_ge_1_5x_later_nadir",
          "detail": "L-0033 1.2 mg/dL vs L-0034 1.6 mg/dL: 0.75x",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "values": [
              1.2,
              1.6
            ]
          },
          "label": "Reverse comparison: admission or peak creatinine >= 1.5x the lowest value in the following 7 days",
          "passed": false,
          "rule_id": "kdigo_aki_2012"
        }
      ],
      "episode_lab_ids": [
        "L-0033",
        "L-0034"
      ],
      "exclusions": [],
      "k_admission": 0,
      "k_peak": 4,
      "n_baselines": 4,
      "peak": {
        "collected_dt": "2026-11-12T15:00:00-05:00",
        "lab_id": "L-0034",
        "loinc": "2160-0",
        "unit": "mg/dL",
        "value": 1.6
      },
      "per_baseline": {
        "back_calculated": {
          "admission": {
            "met": false,
            "ratio": 1.47,
            "stage": 0
          },
          "peak": {
            "lab_id": "L-0034",
            "met": true,
            "ratio": 1.96,
            "stage": 1
          }
        },
        "last_outpatient": {
          "admission": {
            "met": false,
            "ratio": null,
            "stage": 0
          },
          "peak": {
            "lab_id": "L-0034",
            "met": true,
            "ratio": null,
            "stage": 1
          }
        },
        "lowest_365": {
          "admission": {
            "met": false,
            "ratio": null,
            "stage": 0
          },
          "peak": {
            "lab_id": "L-0034",
            "met": true,
            "ratio": null,
            "stage": 1
          }
        },
        "median_365": {
          "admission": {
            "met": false,
            "ratio": null,
            "stage": 0
          },
          "peak": {
            "lab_id": "L-0034",
            "met": true,
            "ratio": null,
            "stage": 1
          }
        }
      },
      "pre_admission_baseline": false,
      "reason": "",
      "reason_code": null,
      "reverse": {
        "days": 7,
        "from": "L-0033",
        "from_value": 1.2,
        "met": false,
        "ratio": 0.75,
        "to": "L-0034",
        "to_value": 1.6
      },
      "robustness": "criteria met under 0 of 4 baselines at admission; 4 of 4 at peak",
      "text": "Creatinine 1.2 mg/dL at admission (lab row L-0033), peak 1.6 mg/dL (lab row L-0034). KDIGO creatinine criterion met: criteria met under 0 of 4 baselines at admission; 4 of 4 at peak. Urine-output criterion not evaluated (no structured source)."
    },
    "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": null,
          "met": false,
          "persistence": {
            "days_apart": null,
            "latest": null,
            "met": false,
            "pair": null,
            "pair_values": null,
            "persistent_value": null,
            "reason": "no qualifying value"
          },
          "reason": "no steady-state creatinine result on file",
          "reason_code": "no_values",
          "route": null,
          "stage": null,
          "status": "not_assessable"
        },
        "2021": {
          "latest": null,
          "met": false,
          "persistence": {
            "days_apart": null,
            "latest": null,
            "met": false,
            "pair": null,
            "pair_values": null,
            "persistent_value": null,
            "reason": "no qualifying value"
          },
          "reason": "no steady-state creatinine result on file",
          "reason_code": "no_values",
          "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: no steady-state creatinine result on file",
          "inputs": {
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "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: no steady-state creatinine result on file",
          "inputs": {
            "dates": [],
            "lab_ids": [],
            "values": []
          },
          "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": "excluded L-0033, L-0034",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0033",
              "L-0034"
            ],
            "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": 75,
          "collected_dt": "2026-11-11T15:00:00-05:00",
          "date": "2026-11-11",
          "egfr_2009": 44.2,
          "egfr_2021": 47.2,
          "excluded": "collected during an admission in which the creatinine-change criteria are met (not steady state)",
          "g_2009": "G3b",
          "g_2021": "G3a",
          "lab_id": "L-0033",
          "scr": 1.2
        },
        {
          "age": 75,
          "collected_dt": "2026-11-12T15:00:00-05:00",
          "date": "2026-11-12",
          "egfr_2009": 31.2,
          "egfr_2021": 33.4,
          "excluded": "collected during an admission in which the creatinine-change criteria are met (not steady state)",
          "g_2009": "G3b",
          "g_2021": "G3b",
          "lab_id": "L-0034",
          "scr": 1.6
        }
      ],
      "exclusions": [],
      "reason": "no steady-state creatinine result on file",
      "robustness": "not assessable",
      "status": "not_assessable",
      "text": "no steady-state creatinine on file. Not assessable: no steady-state creatinine result on file. 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": "304c0a7bc33427366ddb8417dd720b6b31ecb42f57c97ffe4b1daa72672555f4",
  "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": {
      "body_sha256": "98e08ca8b6f5a7f7a68b225b57239006b4664aa533200feaca96e84c0430217b",
      "version": "1.0"
    },
    "kidney_staff": {
      "body_sha256": "fb90888ec65776194e9b5fd58c973b451f4072b64dc12409453c6cd4a8042281",
      "version": "1.0"
    },
    "lab_units": {
      "body_sha256": "a53d26a712b0777f23b4b72dff9d65a8567ca57dadd924bc1ecf0cebc9ac2b18",
      "version": "1.1"
    }
  }
}