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Exact Dx synthetic data · demonstration

← All runs · Open P22

Replay RUN-00022

Live recomputation (nothing written): identical hash

Stored replay hash
608acc46306ee6ac7537634be77803da5102e70bdcc809c657d17d100b08b1e2
Recomputed replay hash
608acc46306ee6ac7537634be77803da5102e70bdcc809c657d17d100b08b1e2
Stored output sha256
cef56acd8ecfe527abf2570b1411a0324f223fc5fa80118dece65b19483b0ab1
Recomputed output sha256
cef56acd8ecfe527abf2570b1411a0324f223fc5fa80118dece65b19483b0ab1
Inputs intact
yes
Engine
kidney-engine 2.0
Trigger
seed · Fri Nov 13, 2026 04:55 PM · audit entry #1625
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": [
    {
      "condition_id": "KC-P22-1",
      "end_date": null,
      "kind": "kidney_transplant",
      "source": "procedure_history",
      "start_date": "2021-05-20"
    }
  ],
  "encounter": {
    "admit_dt": "2026-11-10T09:00:00-05:00",
    "discharge_dt": "2026-11-10T09:40:00-05:00",
    "encounter_id": "KE-P22",
    "setting": "outpatient"
  },
  "labs": [
    {
      "collected_dt": "2026-06-13T09:00:00-04:00",
      "lab_id": "L-0049",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.4
    },
    {
      "collected_dt": "2026-11-10T09:00:00-05:00",
      "lab_id": "L-0050",
      "loinc": "2160-0",
      "unit": "mg/dL",
      "value": 1.5
    }
  ],
  "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": "1973-11-15",
    "patient_id": "P22",
    "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": 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; kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment.",
      "clinician_text": "Not assessable: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment. Nothing to review until the data can decide.",
      "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,
      "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "reason_code": "exclusion",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      },
      "2021": {
        "direction": "NOT_ASSESSABLE",
        "direction_why": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "reason_code": "exclusion",
        "route": null,
        "stage": null,
        "status": "not_assessable"
      }
    },
    "clinician_text": "Not assessable: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment. Nothing to review until the data can decide.",
    "criteria": [
      {
        "criterion_key": "no_exclusion_on_record",
        "detail": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "inputs": {
          "condition_ids": [
            "KC-P22-1"
          ],
          "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": false,
        "rule_id": "kidney_exclusions"
      },
      {
        "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2021",
        "detail": "not assessable: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "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: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
        "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-0049, L-0050",
        "inputs": {
          "dates": [],
          "lab_ids": [
            "L-0049",
            "L-0050"
          ],
          "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
    "drift": false,
    "egfr": [
      {
        "age": 52,
        "collected_dt": "2026-06-13T09:00:00-04:00",
        "date": "2026-06-13",
        "egfr_2009": 43.1,
        "egfr_2021": 45.3,
        "excluded": "not used: kidney transplant on record (the equation is not reliable)",
        "g_2009": "G3b",
        "g_2021": "G3a",
        "lab_id": "L-0049",
        "scr": 1.4
      },
      {
        "age": 52,
        "collected_dt": "2026-11-10T09:00:00-05:00",
        "date": "2026-11-10",
        "egfr_2009": 39.6,
        "egfr_2021": 41.7,
        "excluded": "not used: kidney transplant on record (the equation is not reliable)",
        "g_2009": "G3b",
        "g_2021": "G3b",
        "lab_id": "L-0050",
        "scr": 1.5
      }
    ],
    "exclusions": [
      {
        "condition_id": "KC-P22-1",
        "end_date": null,
        "families": [
          "kidney",
          "aki"
        ],
        "kind": "kidney_transplant",
        "label": "kidney transplant",
        "source": "procedure_history",
        "start_date": "2021-05-20",
        "why": "staging and acute change in a transplanted kidney follow transplant-specific assessment"
      }
    ],
    "note_spans": 0,
    "note_status": "silent",
    "reason": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
    "robustness": "not assessable",
    "stated_stage": null,
    "statement": null,
    "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,
        "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
          "reason_code": "exclusion",
          "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": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
          "reason_code": "exclusion",
          "route": null,
          "stage": null,
          "status": "not_assessable"
        }
      },
      "criteria": [
        {
          "criterion_key": "no_exclusion_on_record",
          "detail": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
          "inputs": {
            "condition_ids": [
              "KC-P22-1"
            ],
            "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": false,
          "rule_id": "kidney_exclusions"
        },
        {
          "criterion_key": "persistence_egfr_lt60_ge90d_ckd_epi_2021",
          "detail": "not assessable: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
          "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: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
          "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-0049, L-0050",
          "inputs": {
            "dates": [],
            "lab_ids": [
              "L-0049",
              "L-0050"
            ],
            "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": 52,
          "collected_dt": "2026-06-13T09:00:00-04:00",
          "date": "2026-06-13",
          "egfr_2009": 43.1,
          "egfr_2021": 45.3,
          "excluded": "not used: kidney transplant on record (the equation is not reliable)",
          "g_2009": "G3b",
          "g_2021": "G3a",
          "lab_id": "L-0049",
          "scr": 1.4
        },
        {
          "age": 52,
          "collected_dt": "2026-11-10T09:00:00-05:00",
          "date": "2026-11-10",
          "egfr_2009": 39.6,
          "egfr_2021": 41.7,
          "excluded": "not used: kidney transplant on record (the equation is not reliable)",
          "g_2009": "G3b",
          "g_2021": "G3b",
          "lab_id": "L-0050",
          "scr": 1.5
        }
      ],
      "exclusions": [
        {
          "condition_id": "KC-P22-1",
          "end_date": null,
          "families": [
            "kidney",
            "aki"
          ],
          "kind": "kidney_transplant",
          "label": "kidney transplant",
          "source": "procedure_history",
          "start_date": "2021-05-20",
          "why": "staging and acute change in a transplanted kidney follow transplant-specific assessment"
        }
      ],
      "reason": "kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment",
      "robustness": "not assessable",
      "status": "not_assessable",
      "text": "Not assessable: kidney transplant on record (procedure history, since 2021-05-20): staging and acute change in a transplanted kidney follow transplant-specific assessment."
    },
    "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": "1dbdf51e10113381fceb27066e53fd922853b9230ccfa040263956813dfa2ea1",
  "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"
    }
  }
}