Concordance Between the Minimum Data Set Kidney Impairment I1500 Item and eGFR Records in Nursing Homes.
Kamila Radjabova, Nina R Joyce, Yu-Chia Hsu and 3 others
PMID 41871835WHAT IT FOUND
The MDS kidney impairment item agreed with eGFR below 60 in only 60.3% of nursing home assessments.
It identified 25.8% of assessments with eGFR below 60. Use lab eGFR for kidney monitoring and medication safety.
Key findings
01In the primary analysis, the MDS I1500 kidney impairment item and eGFR <60 agreed in 60.3% of assessments, with a kappa of 0.19.
02The item detected 25.8% of assessments with eGFR <60 and was negative in 92.3% of assessments without eGFR <60.
03MDS I1500 recorded kidney impairment in 16.4% of assessments, while eGFR <60 was present in 48.2%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
eGFR values were not recalculated and came from different laboratories, with inconsistent equations and race adjustments. eGFR is not a gold standard for kidney function and can be affected by creatinine assay, hydration, and muscle mass. Pairing MDS with eGFR within 7 days may capture temporary kidney changes from dehydration or acute illness rather than stable kidney disease. The study could not measure why labs were ordered or account for staff training, policies, and access to results. The MDS item is meant to record an active diagnosis affecting care, so some eGFR-based mismatches may be appropriate rather than errors.
The easy way to misread this
Do not read the low agreement as proof that every unchecked MDS item represents a missed clinical kidney problem. The MDS item records an active diagnosis affecting care, while eGFR below threshold can be temporary, and the study did not measure patient outcomes.