JMIR Publications

ABSTRACT

Background:

The Cardiovascular-Kidney-Metabolism (CKM) Syndrome has recently been defined as an emerging multi-factorial syndrome characterized by the association between Metabolic Risk Factors (MRF's), Chronic Kidney Disease (CKD), and Cardiovascular Disease (CVD) via a common pathophysiology. The American Heart Association (AHA) has developed the AHA Stages (0-4) of CVD as the primary method for the identification and stratification of risk, however, without an ICD-10-CM code assigned to CKM Syndrome this allows for difficulties when researching how it is documented within both Electronic Health Records and Medicare Administrative Databases.

Objective:

To create a comprehensive and systematic ICD-10-CM coding framework that is in accordance with the AHA’s standards of transparency, reproducibility and compatibility with each CKM stage for use in clinical and public health practice and research.

Methods:

We established associations between ICD-10-CM codes representing core metabolic phenotypes (hypertension, type 2 diabetes, obesity, chronic kidney disease, and metabolic liver disease), key conditions that increase cardiovascular risk (metabolic syndrome, dyslipidemia, obstructive sleep apnoea), and major cardiovascular events (coronary heart disease, heart failure, and stroke). Staged codes were defined based on the AHA definition of stages and were validated against published cohort studies.

Results:

This framework provides code sets for EHR queries and claims algorithms which correspond to each defined stage of CKM existence. Stage 0 comprises no diagnosis of CKM; Stages 1 through 4 consist of a series of four stages of increasing complexity whereby CKM Stage 1 includes the negative diagnostic status of CKM plus an excess of body fat (adipose) tissue; CKM Stage 2 includes CKM Stage 1 and the development of a metabolic syndrome (CVD); CKM Stage 3 represents CKM Stage 1 and CKM Stage 2 plus subclinical or very high-risk CKD; CKM Stage 4 is the clinical diagnosis of overt coronary heart disease (CVD).

Conclusions:

Using this coding structure allows for the consistent identification of cases, the stratification of risk, and the assessment of outcomes across various healthcare systems, thus allowing for collaborative multidisciplinary management, and expediting the research related to CKM syndrome in real-world settings.