Introduction to epocakir

Introduction

The epocakir package makes clinical coding of patients with kidney disease using clinical practice guidelines easy. The guidelines used are the evidence-based KDIGO guidelines. This package covers acute kidney injury (AKI), anemia, and chronic liver disease(CKD).

Features

Examples

library(epocakir)
library(dplyr)
library(units)

Clinical Data

Often clinical data must be cleansed and tidied before analysis can begin. To assist in this, several utility functions have been included. To explore these, consider a sample clinical dataset clinical_obvs:

# Example workflow: clinical_obvs <- read.csv("cohort.csv")
glimpse(clinical_obvs)
#> Rows: 3
#> Columns: 9
#> $ `Patient Number` <chr> "p10001", "p10002", "p10003"
#> $ `Admission Date` <chr> "2020-03-05", "2020-03-06", "2020-03-17"
#> $ `Admission Time` <chr> "14:01:00", "09:10:00", "12:48:00"
#> $ Discharge_date   <chr> "2020-03-10", "2020-03-16", "2020-03-18"
#> $ Discharge_time   <chr> "16:34:00", "18:51:00", "09:12:00"
#> $ `Date of Birth`  <chr> "1956-01-09", "1997-12-04", "1973-05-28"
#> $ Male             <lgl> TRUE, FALSE, TRUE
#> $ Height           <dbl> 182, 161, 168
#> $ Surgery          <lgl> FALSE, FALSE, TRUE

tidy_obvs <- clinical_obvs %>%
  combine_date_time_cols() %>%
  mutate(
    Age = dob2age(`Date of Birth`),
    Height = as_metric(height = set_units(as.numeric(Height), "cm"))
  ) %>%
  binary2factor(Male, Surgery)

glimpse(tidy_obvs)
#> Rows: 3
#> Columns: 8
#> $ `Patient Number`     <chr> "p10001", "p10002", "p10003"
#> $ `Admission DateTime` <dttm> 2020-03-05 14:01:00, 2020-03-06 09:10:00, 202...
#> $ Discharge_DateTime   <dttm> 2020-03-10 16:34:00, 2020-03-16 18:51:00, 202...
#> $ `Date of Birth`      <chr> "1956-01-09", "1997-12-04", "1973-05-28"
#> $ Male                 <ord> Male, Not_Male, Male
#> $ Height               [m] 1.82 [m], 1.61 [m], 1.68 [m]
#> $ Surgery              <ord> Not_Surgery, Not_Surgery, Surgery
#> $ Age                  <Duration> 2064268800s (~65.41 years), 741916800s (~...

Make sure to use set_units() from the units package to convert all measurements into unit objects for automatic unit conversion in epocakir.

AKI Staging

Next consider the sample aki_pt_data dataset. It is possible to use aki_staging() to automatically classify the presence and staging of AKI. If a particular method is required, it is possible to classify AKI using aki_bCr(), aki_SCr() or aki_UO().

# Example workflow: aki_pt_data <- read.csv("aki.csv")
head(aki_pt_data)
#> # A tibble: 6 x 7
#>       SCr_    bCr_ pt_id_ dttm_                   UO_ aki_staging_type aki_     
#>    [mg/dl] [mg/dl] <chr>  <dttm>              [ml/kg] <chr>            <ord>    
#> 1      2.0     1.5 <NA>   NA                       NA aki_bCr          No AKI   
#> 2      2.5     1.5 <NA>   NA                       NA aki_bCr          AKI Stag~
#> 3      3.0     1.5 <NA>   NA                       NA aki_bCr          AKI Stag~
#> 4      3.5     1.5 <NA>   NA                       NA aki_bCr          AKI Stag~
#> 5      4.0     1.5 <NA>   NA                       NA aki_bCr          AKI Stag~
#> 6      4.5     1.5 <NA>   NA                       NA aki_bCr          AKI Stag~

aki_staging(aki_pt_data,
  SCr = "SCr_", bCr = "bCr_", UO = "UO_",
  dttm = "dttm_", pt_id = "pt_id_"
)
#>  [1] No AKI      AKI Stage 1 AKI Stage 2 AKI Stage 2 AKI Stage 3 AKI Stage 3
#>  [7] No AKI      No AKI      AKI Stage 1 No AKI      No AKI      AKI Stage 1
#> [13] No AKI      No AKI      No AKI      AKI Stage 1 No AKI      AKI Stage 2
#> [19] AKI Stage 3 AKI Stage 1 AKI Stage 3 AKI Stage 2 No AKI      AKI Stage 1
#> [25] AKI Stage 3 AKI Stage 3 No AKI     
#> Levels: No AKI < AKI Stage 1 < AKI Stage 2 < AKI Stage 3

aki_pt_data %>%
  mutate(aki = aki_staging(
    SCr = SCr_, bCr = bCr_, UO = UO_,
    dttm = dttm_, pt_id = pt_id_
  )) %>%
  select(pt_id_, SCr_:dttm_, aki)
#> # A tibble: 27 x 5
#>    pt_id_    SCr_    bCr_ dttm_               aki        
#>    <chr>  [mg/dl] [mg/dl] <dttm>              <ord>      
#>  1 <NA>       2.0     1.5 NA                  No AKI     
#>  2 <NA>       2.5     1.5 NA                  AKI Stage 1
#>  3 <NA>       3.0     1.5 NA                  AKI Stage 2
#>  4 <NA>       3.5     1.5 NA                  AKI Stage 2
#>  5 <NA>       4.0     1.5 NA                  AKI Stage 3
#>  6 <NA>       4.5     1.5 NA                  AKI Stage 3
#>  7 pt1        3.4      NA 2020-10-23 09:00:00 No AKI     
#>  8 pt1        3.9      NA 2020-10-25 21:00:00 No AKI     
#>  9 pt1        3.0      NA 2020-10-20 09:00:00 AKI Stage 1
#> 10 pt2        3.4      NA 2020-10-18 22:00:00 No AKI     
#> # ... with 17 more rows

aki_pt_data %>%
  mutate(aki = aki_SCr(
    SCr = SCr_, dttm = dttm_, pt_id = pt_id_
  )) %>%
  select(pt_id_, SCr_:dttm_, aki)
#> # A tibble: 27 x 5
#>    pt_id_    SCr_    bCr_ dttm_               aki        
#>    <chr>  [mg/dl] [mg/dl] <dttm>              <ord>      
#>  1 <NA>       2.0     1.5 NA                  No AKI     
#>  2 <NA>       2.5     1.5 NA                  No AKI     
#>  3 <NA>       3.0     1.5 NA                  No AKI     
#>  4 <NA>       3.5     1.5 NA                  No AKI     
#>  5 <NA>       4.0     1.5 NA                  No AKI     
#>  6 <NA>       4.5     1.5 NA                  No AKI     
#>  7 pt1        3.4      NA 2020-10-23 09:00:00 No AKI     
#>  8 pt1        3.9      NA 2020-10-25 21:00:00 No AKI     
#>  9 pt1        3.0      NA 2020-10-20 09:00:00 AKI Stage 1
#> 10 pt2        3.4      NA 2020-10-18 22:00:00 No AKI     
#> # ... with 17 more rows

Estimated Glomerular Filtration Rate

Similarly, eGFR() offers the ability to automatically select the appropriate formula to estimate the glomerular filtration rate. If a particular formula is required, then eGFR_adult_SCr, eGFR_adult_SCysC, eGFR_adult_SCr_SCysC, eGFR_child_SCr, eGFR_child_SCr_BUN, or eGFR_child_SCysC can be used.

# Example workflow: aki_pt_data <- read.csv("aki.csv")
head(eGFR_pt_data)
#> # A tibble: 6 x 10
#>       SCr_   SCysC_     Age_ male_ black_  height_     BUN_ eGFR_calc_type_
#>    [mg/dl]   [mg/L]  [years] <lgl> <lgl>       [m]  [mg/dl] <chr>          
#> 1      0.5       NA       20 FALSE FALSE        NA       NA eGFR_adult_SCr 
#> 2       NA      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCy~
#> 3      0.5      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCr~
#> 4      0.5       NA       30 FALSE TRUE         NA       NA eGFR_adult_SCr 
#> 5       NA      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCy~
#> 6      0.5      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCr~
#> # ... with 2 more variables: eGFR_ [mL/1.73m2/min], pediatric_ <lgl>

eGFR(eGFR_pt_data,
  SCr = "SCr_", SCysC = "SCysC_",
  Age = "Age_", height = "height_", BUN = "BUN_",
  male = "male_", black = "black_", pediatric = "pediatric_"
)
#> Units: [mL/1.73m2/min]
#>  [1] 139.32466 161.68446 166.81886 150.52336 155.33226 171.35616 139.32466
#>  [8]  66.77365  96.41798 150.52336  64.15027  99.04045  49.63420 161.68446
#> [15]  97.06854  53.62373 155.33226  99.70870  49.63420  66.77365  56.10368
#> [22]  53.62373  64.15027  57.62964 155.99874 173.48118 178.86404 168.53768
#> [29] 166.66552 183.72895 155.99874  71.64555 103.37985 168.53768  68.83077
#> [36] 106.19167  66.06766 173.48118 116.50660  71.37808 166.66552 119.67546
#> [43]  66.06766  71.64555  67.33849  71.37808  68.83077  69.17003  99.12000
#> [50] 148.21219 165.89761

eGFR_pt_data %>%
  dplyr::mutate(eGFR = eGFR(
    SCr = SCr_, SCysC = SCysC_,
    Age = Age_, height = height_, BUN = BUN_,
    male = male_, black = black_, pediatric = pediatric_
  )) %>%
  select(SCr_:pediatric_, eGFR)
#> # A tibble: 51 x 11
#>        SCr_   SCysC_     Age_ male_ black_  height_     BUN_ eGFR_calc_type_
#>     [mg/dl]   [mg/L]  [years] <lgl> <lgl>       [m]  [mg/dl] <chr>          
#>  1      0.5       NA       20 FALSE FALSE        NA       NA eGFR_adult_SCr 
#>  2       NA      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCy~
#>  3      0.5      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCr~
#>  4      0.5       NA       30 FALSE TRUE         NA       NA eGFR_adult_SCr 
#>  5       NA      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCy~
#>  6      0.5      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCr~
#>  7      0.5       NA       20 FALSE FALSE        NA       NA eGFR_adult_SCr 
#>  8       NA      1.2       20 FALSE FALSE        NA       NA eGFR_adult_SCy~
#>  9      0.5      1.2       20 FALSE FALSE        NA       NA eGFR_adult_SCr~
#> 10      0.5       NA       30 FALSE TRUE         NA       NA eGFR_adult_SCr 
#> # ... with 41 more rows, and 3 more variables: eGFR_ [mL/1.73m2/min],
#> #   pediatric_ <lgl>, eGFR [mL/1.73m2/min]

eGFR_pt_data %>%
  dplyr::mutate(eGFR = eGFR_adult_SCr(
    SCr = SCr_, Age = Age_, male = male_, black = black_
  )) %>%
  select(SCr_:pediatric_, eGFR)
#> # A tibble: 51 x 11
#>        SCr_   SCysC_     Age_ male_ black_  height_     BUN_ eGFR_calc_type_
#>     [mg/dl]   [mg/L]  [years] <lgl> <lgl>       [m]  [mg/dl] <chr>          
#>  1      0.5       NA       20 FALSE FALSE        NA       NA eGFR_adult_SCr 
#>  2       NA      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCy~
#>  3      0.5      0.4       20 FALSE FALSE        NA       NA eGFR_adult_SCr~
#>  4      0.5       NA       30 FALSE TRUE         NA       NA eGFR_adult_SCr 
#>  5       NA      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCy~
#>  6      0.5      0.4       30 FALSE TRUE         NA       NA eGFR_adult_SCr~
#>  7      0.5       NA       20 FALSE FALSE        NA       NA eGFR_adult_SCr 
#>  8       NA      1.2       20 FALSE FALSE        NA       NA eGFR_adult_SCy~
#>  9      0.5      1.2       20 FALSE FALSE        NA       NA eGFR_adult_SCr~
#> 10      0.5       NA       30 FALSE TRUE         NA       NA eGFR_adult_SCr 
#> # ... with 41 more rows, and 3 more variables: eGFR_ [mL/1.73m2/min],
#> #   pediatric_ <lgl>, eGFR [mL/1.73m2/min]

Reference

See https://alwinw.github.io/epocakir/reference/index.html for more usage details and package reference.

See https://kdigo.org/guidelines/ for full KDIGO guidelines.