FHIR Clinical Guidelines (v1.0.0) (STU1)

This page is part of the Clinical Guidelines (v1.0.0: STU 1) based on FHIR R4. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

CKDRiskLogic

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Raw ttl 


@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .

# - resource -------------------------------------------------------------------

 a fhir:Library;
  fhir:nodeRole fhir:treeRoot;
  fhir:Resource.id [ fhir:value "CKDRiskLogic"];
  fhir:Resource.meta [
     fhir:Meta.profile [
       fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computablelibrary";
       fhir:index 0;
       fhir:link <http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-computablelibrary>     ]
  ];
  fhir:DomainResource.text [
     fhir:Narrative.status [ fhir:value "generated" ];
     fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><h2>Contents</h2><p><code>text/cql</code></p><pre><code class=\"language-sql\">library CKDRiskLogic version '1.0'\n\nusing FHIR version '4.0.0'\n\ninclude FHIRHelpers version '4.0.0' called FHIRHelpers\n\ncodesystem \"SNOMEDCT\": 'http://snomed.info/sct'\ncodesystem \"LOINC\": 'http://loinc.org'\ncodesystem \"RxNorm\": 'http://www.nlm.nih.gov/research/umls/rxnorm'\n\nvalueset \"Chronic Kidney Disease\": 'ckd-valueset-ckd'\nvalueset \"Diabetes mellitus\": 'ckd-valueset-diabetes'\n\nvalueset \"eGFR Labs\": 'ckd-valueset-egfr'\nvalueset \"UACR Labs\": 'ckd-valueset-uacr'\nvalueset \"Creatinine Labs\": 'ckd-valueset-creatinine'\n\ncode \"Blood pressure systolic and diastolic\": '55284-4' from \"LOINC\"\n\ncontext Patient\n\n// Conditions\n//\ndefine \"Has CKD or Diabetes\":\n  \"Has CKD\" or \"Has Diabetes\"\n\ndefine \"Has CKD\":\n  exists( \"Chronic Kidney Disease Dx\" )\n\ndefine \"Has Diabetes\":\n  exists( \"Diabetes Dx\" )\n\ndefine \"CKD or Diabetes Dx\":\n  \"Chronic Kidney Disease Dx\" union \"Diabetes Dx\"\n\ndefine \"Chronic Kidney Disease Dx\":\n  [Condition: code in \"Chronic Kidney Disease\"] condition\n    where condition.clinicalStatus.value in { 'active', 'recurrence' }\n\ndefine \"Diabetes Dx\":\n  [Condition: code in \"Diabetes mellitus\"] condition\n    where condition.clinicalStatus.value in { 'active', 'recurrence' }\n\n// Laboratory observations\n//\ndefine \"Has eGFR or UACR Lab\":\n  \"Last eGFR Lab Result\" is not null\n	or \"Last UACR Lab Result\" is not null\n\ndefine \"Last eGFR Lab Result\":\n  Last( [Observation: code in \"eGFR Labs\"] )\n\ndefine \"Last eGFR Quantity\":\n  \"Last eGFR Lab Result\" Result\n    return ToQuantity(Result.value as Quantity)\n\ndefine \"Has Abnormal eGFR\":\n  \"Last eGFR Quantity\".value &lt; 60\n\ndefine \"Last UACR Lab Result\":\n  Last( [Observation: code in \"UACR Labs\"] )\n\ndefine \"Last UACR Quantity\":\n  \"Last UACR Lab Result\" Result\n    return ToQuantity(Result.value as Quantity)\n\ndefine \"Has Abnormal UACR\":\n  \"Last UACR Quantity\" uacr\n    return UACRtoMetric(uacr).value &gt; 30\n\ndefine \"Last Creatinine Lab Result\":\n  Last( [Observation: code in \"Creatinine Labs\"] )\n\ndefine \"Last Creatinine Quantity\":\n  \"Last Creatinine Lab Result\" Result\n    return ToQuantity(Result.value as Quantity)\n\ndefine \"Needs eGFR Lab\":\n	\"eGFR Lab is Overdue\"\n		or (\"eGFR Lab Frequency\" is not null and \"Last eGFR Lab Result\" is null)\n\ndefine \"eGFR Lab Frequency\":\n	case\n		when \"CKD Stage\" &gt;= 4\n			then 3 months\n		when \"CKD Stage\" &gt;= 3\n			then 6 months\n		when \"Has CKD or Diabetes\"\n			then 12 months\n		else null\n	end\n\ndefine \"eGFR Lab is Overdue\":\n  \"Last eGFR Lab Result\" Result\n    return\n      case\n        when Result.effective is null\n          then true\n        when Result.effective is dateTime\n          then (Result.effective.value + \"eGFR Lab Frequency\") &lt; Today()\n        when Result.effective is Period\n          then (end of PeriodToInterval(Result.effective) + \"eGFR Lab Frequency\") &lt; Today()\n        else false\n      end\n\ndefine NeedsGFRSummary: 'Order Renal Lab Panel'\n\ndefine NeedsGFRDetail:\n	case\n		when \"CKD Stage\" &gt;= 1\n			then 'eGFR lab recommended every ' + ToString(\"eGFR Lab Frequency\") + ' for Stage ' + ToString(\"CKD Stage\") + ' CKD.'\n		when \"Has CKD or Diabetes\"\n			then 'eGFR lab recommended every ' + ToString(\"eGFR Lab Frequency\") + ' for CKD or Diabetes.'\n		else null\n	end\n\ndefine NeedsGFRSeverity: 'info'\n\ndefine \"CKD Stage\":\n  \"Last eGFR Quantity\" egfr\n  	return case\n      when egfr.value &lt; 15\n    		then 5\n    	when egfr.value &lt; 30\n    		then 4\n    	when egfr.value &lt; 60\n    		then 3\n    	when egfr.value &lt; 90\n    		then 2\n    	when egfr.value &gt;= 90\n        // TODO this does not parse\n        //case  when UACRtoMetric(\"Get UACR Quantity\").value &gt; 20\n  		  //  then 1\n        //else 0\n        //end\n        then 0\n      else 0\n  	end\n\n// Referrals\n//\ndefine \"Recommend Nephrology Referral\":\n	\"5-Year Risk Level\" = 'High'\n\ndefine NephrologyReferralDetail: 'Referral to a nephrologist is recommended when 5-year risk is High'\n\ndefine NephrologyReferralSeverity: 'info'\n\n//\n// Tangri CKD risk model\n//\n// 4 variable\n// 1 – 0.9750 ^ exp (-0.2201 × (age/10 – 7.036) + 0.2467 × (male – 0.5642) – 0.5567 × (eGFR/5 – 7.222) + 0.4510 × (logACR – 5.137))\n// 5 year factor =  0.9240\n//\n// 8 variable\n// 1 – 0.9780 ^ exp (-0.1992 × (age/10 – 7.036) + 0.1602 × (male – 0.5642) – 0.4919 × (eGFR/5 – 7.222) + 0.3364 × (logACR – 5.137)\n//		– 0.3441 × (albumin – 3.997) + 0.2604 × (phosphorous – 3.916) – 0.07354 × (bicarbonate – 25.57) – 0.2228 × (calcium – 9.355))\n// 5 year factor = 0.9301\n\ndefine \"2-YearRiskDetail\":\n	'2-year kidney failure risk of ' + ToString(\"2-Year CKD Risk Percent\") + '% is considered to be ' + \"2-Year Risk Level\" + ' risk.'\n\ndefine \"5-YearRiskDetail\":\n	'5-year kidney failure risk of ' + ToString(\"5-Year CKD Risk Percent\") + '% is considered to be ' + \"5-Year Risk Level\" + ' risk.'\n\ndefine \"2-YearRiskSeverity\": if \"2-Year Risk Level\" = 'High' then 'warning' else 'info'\n\ndefine \"5-YearRiskSeverity\": if \"5-Year Risk Level\" = 'High' then 'warning' else 'info'\n\ndefine \"2-Year CKD Risk Percent\":\n  \"2-Year CKD Risk\" risk\n    return Round(risk * 100, 2)\n\ndefine \"5-Year CKD Risk Percent\":\n  \"5-Year CKD Risk\" risk\n    return Round(risk * 100, 2)\n\ndefine \"2-Year CKD Risk\":\n  \"Last eGFR Quantity\" egfr\n    return calculateCkdRisk(0.9750, 0, AgeInYears(), egfr, UACRtoMetric(\"Last UACR Quantity\"))\n\ndefine \"5-Year CKD Risk\":\n  \"Last eGFR Quantity\" egfr\n    return calculateCkdRisk(0.9240, 0, AgeInYears(), egfr, UACRtoMetric(\"Last UACR Quantity\"))\n\n// The ckdFactor is a variable determined by (Non-) North American location and whether calculation is 2 or 5 year prediction\ndefine function calculateCkdRisk(ckdFactor Decimal, sex Integer, age Integer, egfr System.Quantity, acr System.Quantity):\n  1.0 - Power(ckdFactor, Exp(-0.2201 * (age / 10 - 7.036) + 0.2467 * (sex - 0.5642) - 0.5567 * (egfr.value / 5 - 7.222) + 0.4510 * (Ln(acr.value) - 5.137)))\n\ndefine \"2-Year Risk Level\":\n  \"2-Year CKD Risk Percent\" riskPercent\n  	return case\n      when riskPercent &lt; 5\n    		then 'Low'\n    	when riskPercent &lt; 15\n    		then 'Intermediate'\n    	when riskPercent &gt; 15\n    		then 'High'\n      else null\n  	end\n\ndefine \"5-Year Risk Level\":\n  \"5-Year CKD Risk Percent\" riskPercent\n  	return case\n      when riskPercent &lt; 5\n    		then 'Low'\n    	when riskPercent &lt; 15\n    		then 'Intermediate'\n    	when riskPercent &gt; 15\n    		then 'High'\n      else null\n  	end\n\n// Conversion functions\n\ndefine function PeriodToInterval(value FHIR.Period):\n	Interval[value.\"start\".value, value.\"end\".value]\n\ndefine function CodingToCode(coding FHIR.Coding):\n	System.Code {\n		code: coding.code.value,\n		system: coding.system.value,\n		version: coding.version.value,\n		display: coding.display.value\n	}\n\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    System.Concept {\n        codes: concept.coding C return CodingToCode(C),\n        display: concept.text.value\n    }\n\ndefine function ToQuantity(quantity FHIR.Quantity):\n    System.Quantity {\n        value: quantity.value.value,\n        unit: quantity.unit.value\n    }\n\ndefine function UACRtoMetric(qty System.Quantity):\n	case when qty.unit = 'mg/mmol creatinine' then\n		System.Quantity { value: qty.value * 8.84, unit: 'mg/g' }\n	when qty.unit = 'mg/g' then\n    qty\n	else\n    // unknown units, ignore this quantity in calculation\n		null\n	end\n\ndefine function ToMetric(qty System.Quantity):\n	case when qty.unit = 'lb' then\n		System.Quantity { value: qty.value * 0.454, unit: 'kg' }\n	when qty.unit = 'in' then\n		System.Quantity { value: qty.value * 0.0254, unit: 'm' }\n	else\n		qty\n	end\n</code></pre></div>"
  ];
  fhir:DomainResource.extension [
     fhir:index 0;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.valueCode [ fhir:value "shareable" ]
  ], [
     fhir:index 1;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.valueCode [ fhir:value "computable" ]
  ], [
     fhir:index 2;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability" ];
     fhir:Extension.valueCode [ fhir:value "publishable" ]
  ], [
     fhir:index 3;
     fhir:Extension.url [ fhir:value "http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeRepresentationLevel" ];
     fhir:Extension.valueCode [ fhir:value "structured" ]
  ];
  fhir:Library.url [ fhir:value "http://hl7.org/fhir/uv/cpg/Library/CKDRiskLogic"];
  fhir:Library.version [ fhir:value "1.0.0"];
  fhir:Library.name [ fhir:value "CKDRiskLogic"];
  fhir:Library.title [ fhir:value "Chronic Kidney Disease (CKD) risk screening logic"];
  fhir:Library.status [ fhir:value "active"];
  fhir:Library.experimental [ fhir:value "true"^^xsd:boolean];
  fhir:Library.type [
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://terminology.hl7.org/CodeSystem/library-type" ];
       fhir:Coding.code [ fhir:value "logic-library" ]     ]
  ];
  fhir:Library.date [ fhir:value "2021-02-11T20:30:11+00:00"^^xsd:dateTime];
  fhir:Library.publisher [ fhir:value "HL7 FHIR Clinical Guidelines Example Artifact"];
  fhir:Library.description [ fhir:value "Chronic Kidney Disease (CKD) risk screening logic"];
  fhir:Library.jurisdiction [
     fhir:index 0;
     fhir:CodeableConcept.coding [
       fhir:index 0;
       fhir:Coding.system [ fhir:value "http://unstats.un.org/unsd/methods/m49/m49.htm" ];
       fhir:Coding.code [ fhir:value "001" ];
       fhir:Coding.display [ fhir:value "World" ]     ]
  ];
  fhir:Library.content [
     fhir:index 0;
     fhir:Attachment.contentType [ fhir:value "text/cql" ];
     fhir:Attachment.data [ fhir:value "library CKDRiskLogic version '1.0'

using FHIR version '4.0.0'

include FHIRHelpers version '4.0.0' called FHIRHelpers

codesystem "SNOMEDCT": 'http://snomed.info/sct'
codesystem "LOINC": 'http://loinc.org'
codesystem "RxNorm": 'http://www.nlm.nih.gov/research/umls/rxnorm'

valueset "Chronic Kidney Disease": 'ckd-valueset-ckd'
valueset "Diabetes mellitus": 'ckd-valueset-diabetes'

valueset "eGFR Labs": 'ckd-valueset-egfr'
valueset "UACR Labs": 'ckd-valueset-uacr'
valueset "Creatinine Labs": 'ckd-valueset-creatinine'

code "Blood pressure systolic and diastolic": '55284-4' from "LOINC"

context Patient

// Conditions
//
define "Has CKD or Diabetes":
  "Has CKD" or "Has Diabetes"

define "Has CKD":
  exists( "Chronic Kidney Disease Dx" )

define "Has Diabetes":
  exists( "Diabetes Dx" )

define "CKD or Diabetes Dx":
  "Chronic Kidney Disease Dx" union "Diabetes Dx"

define "Chronic Kidney Disease Dx":
  [Condition: code in "Chronic Kidney Disease"] condition
    where condition.clinicalStatus.value in { 'active', 'recurrence' }

define "Diabetes Dx":
  [Condition: code in "Diabetes mellitus"] condition
    where condition.clinicalStatus.value in { 'active', 'recurrence' }

// Laboratory observations
//
define "Has eGFR or UACR Lab":
  "Last eGFR Lab Result" is not null
	or "Last UACR Lab Result" is not null

define "Last eGFR Lab Result":
  Last( [Observation: code in "eGFR Labs"] )

define "Last eGFR Quantity":
  "Last eGFR Lab Result" Result
    return ToQuantity(Result.value as Quantity)

define "Has Abnormal eGFR":
  "Last eGFR Quantity".value < 60

define "Last UACR Lab Result":
  Last( [Observation: code in "UACR Labs"] )

define "Last UACR Quantity":
  "Last UACR Lab Result" Result
    return ToQuantity(Result.value as Quantity)

define "Has Abnormal UACR":
  "Last UACR Quantity" uacr
    return UACRtoMetric(uacr).value > 30

define "Last Creatinine Lab Result":
  Last( [Observation: code in "Creatinine Labs"] )

define "Last Creatinine Quantity":
  "Last Creatinine Lab Result" Result
    return ToQuantity(Result.value as Quantity)

define "Needs eGFR Lab":
	"eGFR Lab is Overdue"
		or ("eGFR Lab Frequency" is not null and "Last eGFR Lab Result" is null)

define "eGFR Lab Frequency":
	case
		when "CKD Stage" >= 4
			then 3 months
		when "CKD Stage" >= 3
			then 6 months
		when "Has CKD or Diabetes"
			then 12 months
		else null
	end

define "eGFR Lab is Overdue":
  "Last eGFR Lab Result" Result
    return
      case
        when Result.effective is null
          then true
        when Result.effective is dateTime
          then (Result.effective.value + "eGFR Lab Frequency") < Today()
        when Result.effective is Period
          then (end of PeriodToInterval(Result.effective) + "eGFR Lab Frequency") < Today()
        else false
      end

define NeedsGFRSummary: 'Order Renal Lab Panel'

define NeedsGFRDetail:
	case
		when "CKD Stage" >= 1
			then 'eGFR lab recommended every ' + ToString("eGFR Lab Frequency") + ' for Stage ' + ToString("CKD Stage") + ' CKD.'
		when "Has CKD or Diabetes"
			then 'eGFR lab recommended every ' + ToString("eGFR Lab Frequency") + ' for CKD or Diabetes.'
		else null
	end

define NeedsGFRSeverity: 'info'

define "CKD Stage":
  "Last eGFR Quantity" egfr
  	return case
      when egfr.value < 15
    		then 5
    	when egfr.value < 30
    		then 4
    	when egfr.value < 60
    		then 3
    	when egfr.value < 90
    		then 2
    	when egfr.value >= 90
        // TODO this does not parse
        //case  when UACRtoMetric("Get UACR Quantity").value > 20
  		  //  then 1
        //else 0
        //end
        then 0
      else 0
  	end

// Referrals
//
define "Recommend Nephrology Referral":
	"5-Year Risk Level" = 'High'

define NephrologyReferralDetail: 'Referral to a nephrologist is recommended when 5-year risk is High'

define NephrologyReferralSeverity: 'info'

//
// Tangri CKD risk model
//
// 4 variable
// 1 – 0.9750 ^ exp (-0.2201 × (age/10 – 7.036) + 0.2467 × (male – 0.5642) – 0.5567 × (eGFR/5 – 7.222) + 0.4510 × (logACR – 5.137))
// 5 year factor =  0.9240
//
// 8 variable
// 1 – 0.9780 ^ exp (-0.1992 × (age/10 – 7.036) + 0.1602 × (male – 0.5642) – 0.4919 × (eGFR/5 – 7.222) + 0.3364 × (logACR – 5.137)
//		– 0.3441 × (albumin – 3.997) + 0.2604 × (phosphorous – 3.916) – 0.07354 × (bicarbonate – 25.57) – 0.2228 × (calcium – 9.355))
// 5 year factor = 0.9301

define "2-YearRiskDetail":
	'2-year kidney failure risk of ' + ToString("2-Year CKD Risk Percent") + '% is considered to be ' + "2-Year Risk Level" + ' risk.'

define "5-YearRiskDetail":
	'5-year kidney failure risk of ' + ToString("5-Year CKD Risk Percent") + '% is considered to be ' + "5-Year Risk Level" + ' risk.'

define "2-YearRiskSeverity": if "2-Year Risk Level" = 'High' then 'warning' else 'info'

define "5-YearRiskSeverity": if "5-Year Risk Level" = 'High' then 'warning' else 'info'

define "2-Year CKD Risk Percent":
  "2-Year CKD Risk" risk
    return Round(risk * 100, 2)

define "5-Year CKD Risk Percent":
  "5-Year CKD Risk" risk
    return Round(risk * 100, 2)

define "2-Year CKD Risk":
  "Last eGFR Quantity" egfr
    return calculateCkdRisk(0.9750, 0, AgeInYears(), egfr, UACRtoMetric("Last UACR Quantity"))

define "5-Year CKD Risk":
  "Last eGFR Quantity" egfr
    return calculateCkdRisk(0.9240, 0, AgeInYears(), egfr, UACRtoMetric("Last UACR Quantity"))

// The ckdFactor is a variable determined by (Non-) North American location and whether calculation is 2 or 5 year prediction
define function calculateCkdRisk(ckdFactor Decimal, sex Integer, age Integer, egfr System.Quantity, acr System.Quantity):
  1.0 - Power(ckdFactor, Exp(-0.2201 * (age / 10 - 7.036) + 0.2467 * (sex - 0.5642) - 0.5567 * (egfr.value / 5 - 7.222) + 0.4510 * (Ln(acr.value) - 5.137)))

define "2-Year Risk Level":
  "2-Year CKD Risk Percent" riskPercent
  	return case
      when riskPercent < 5
    		then 'Low'
    	when riskPercent < 15
    		then 'Intermediate'
    	when riskPercent > 15
    		then 'High'
      else null
  	end

define "5-Year Risk Level":
  "5-Year CKD Risk Percent" riskPercent
  	return case
      when riskPercent < 5
    		then 'Low'
    	when riskPercent < 15
    		then 'Intermediate'
    	when riskPercent > 15
    		then 'High'
      else null
  	end

// Conversion functions

define function PeriodToInterval(value FHIR.Period):
	Interval[value."start".value, value."end".value]

define function CodingToCode(coding FHIR.Coding):
	System.Code {
		code: coding.code.value,
		system: coding.system.value,
		version: coding.version.value,
		display: coding.display.value
	}

define function ToConcept(concept FHIR.CodeableConcept):
    System.Concept {
        codes: concept.coding C return CodingToCode(C),
        display: concept.text.value
    }

define function ToQuantity(quantity FHIR.Quantity):
    System.Quantity {
        value: quantity.value.value,
        unit: quantity.unit.value
    }

define function UACRtoMetric(qty System.Quantity):
	case when qty.unit = 'mg/mmol creatinine' then
		System.Quantity { value: qty.value * 8.84, unit: 'mg/g' }
	when qty.unit = 'mg/g' then
    qty
	else
    // unknown units, ignore this quantity in calculation
		null
	end

define function ToMetric(qty System.Quantity):
	case when qty.unit = 'lb' then
		System.Quantity { value: qty.value * 0.454, unit: 'kg' }
	when qty.unit = 'in' then
		System.Quantity { value: qty.value * 0.0254, unit: 'm' }
	else
		qty
	end
"^^xsd:base64Binary ]
  ].

# - ontology header ------------------------------------------------------------

 a owl:Ontology;
  owl:imports fhir:fhir.ttl.