Novel methods for tracking long-term maintenance immunosuppression regimens

Paula M. Buchanan, Mark A. Schnitzler, Daniel Brennan, Nino Dzebisashvili, Lisa M. Willoughby, David Axelrod, Paolo R. Salvalaggio, Kevin C. Abbott, Thomas E. Burroughs, Krista L. Lentine

Research output: Contribution to journalArticle

Abstract

Background and objectives: Accurate assessment of the use of immunosuppressive medications is vital for observational analyses that are widely used in transplantation research. This study assessed the accuracy of three potential sources of maintenance immunosuppression data. Design, setting, participants, & measurements: This study investigated the agreement of immunosuppression information in directly linked electronic medical records for Medicare beneficiaries who received a kidney transplant at one center in 1998 through 2001, Organ Procurement and Transplantation Network (OPTN) survey data, and Medicare pharmacy claims. Pair-wise, interdata concordance (Κ) and percentage agreement statistics were used to compare immunosuppression regimens reported at discharge, and at 6 mo and 1 yr after transplantation in each data source. Results: Among 181 eligible participants, agreement between data sources for nonsteroid immunosuppression increased with time after transplantation. By 1-yr, concordance was excellent for calcineurin inhibitors and mycophenolate mofetil (Κ = 0.79 to 1.00), and very good for azathioprine (κ = 0.73 to 0.85). Similarly, percentage agreement at 1 yr was 94.9 to 100% for calcineurin inhibitors, 91.1 to 95.7% for mycophenolate mofetil, and 87.5 to 92.8% for azathioprine. Widening the comparison time window resolved 33.6% of cases with discordant indications of calcineurin inhibitor and/or antimetabolite use in claims compared with other data sources. Conclusions: This analysis supports the accuracy of the three sources of data for description of nonsteroid immunosuppression after kidney transplantation. Given the current strategic focus on reducing collection of data, use of alternative measures of immunosuppression exposure is appropriate and will assume greater importance.

Original languageEnglish (US)
Pages (from-to)117-124
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2008
Externally publishedYes

Fingerprint

Immunosuppression
Information Storage and Retrieval
Mycophenolic Acid
Transplantation
Azathioprine
Medicare
Antimetabolites
Tissue and Organ Procurement
Electronic Health Records
Organ Transplantation
Immunosuppressive Agents
Kidney Transplantation
Maintenance
Transplants
Kidney
Research
Calcineurin Inhibitors

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Buchanan, P. M., Schnitzler, M. A., Brennan, D., Dzebisashvili, N., Willoughby, L. M., Axelrod, D., ... Lentine, K. L. (2008). Novel methods for tracking long-term maintenance immunosuppression regimens. Clinical Journal of the American Society of Nephrology, 3(1), 117-124. https://doi.org/10.2215/CJN.02790707

Novel methods for tracking long-term maintenance immunosuppression regimens. / Buchanan, Paula M.; Schnitzler, Mark A.; Brennan, Daniel; Dzebisashvili, Nino; Willoughby, Lisa M.; Axelrod, David; Salvalaggio, Paolo R.; Abbott, Kevin C.; Burroughs, Thomas E.; Lentine, Krista L.

In: Clinical Journal of the American Society of Nephrology, Vol. 3, No. 1, 01.01.2008, p. 117-124.

Research output: Contribution to journalArticle

Buchanan, PM, Schnitzler, MA, Brennan, D, Dzebisashvili, N, Willoughby, LM, Axelrod, D, Salvalaggio, PR, Abbott, KC, Burroughs, TE & Lentine, KL 2008, 'Novel methods for tracking long-term maintenance immunosuppression regimens', Clinical Journal of the American Society of Nephrology, vol. 3, no. 1, pp. 117-124. https://doi.org/10.2215/CJN.02790707
Buchanan, Paula M. ; Schnitzler, Mark A. ; Brennan, Daniel ; Dzebisashvili, Nino ; Willoughby, Lisa M. ; Axelrod, David ; Salvalaggio, Paolo R. ; Abbott, Kevin C. ; Burroughs, Thomas E. ; Lentine, Krista L. / Novel methods for tracking long-term maintenance immunosuppression regimens. In: Clinical Journal of the American Society of Nephrology. 2008 ; Vol. 3, No. 1. pp. 117-124.
@article{4a8c32c97dae42cfac05dbdf411bbf43,
title = "Novel methods for tracking long-term maintenance immunosuppression regimens",
abstract = "Background and objectives: Accurate assessment of the use of immunosuppressive medications is vital for observational analyses that are widely used in transplantation research. This study assessed the accuracy of three potential sources of maintenance immunosuppression data. Design, setting, participants, & measurements: This study investigated the agreement of immunosuppression information in directly linked electronic medical records for Medicare beneficiaries who received a kidney transplant at one center in 1998 through 2001, Organ Procurement and Transplantation Network (OPTN) survey data, and Medicare pharmacy claims. Pair-wise, interdata concordance (Κ) and percentage agreement statistics were used to compare immunosuppression regimens reported at discharge, and at 6 mo and 1 yr after transplantation in each data source. Results: Among 181 eligible participants, agreement between data sources for nonsteroid immunosuppression increased with time after transplantation. By 1-yr, concordance was excellent for calcineurin inhibitors and mycophenolate mofetil (Κ = 0.79 to 1.00), and very good for azathioprine (κ = 0.73 to 0.85). Similarly, percentage agreement at 1 yr was 94.9 to 100{\%} for calcineurin inhibitors, 91.1 to 95.7{\%} for mycophenolate mofetil, and 87.5 to 92.8{\%} for azathioprine. Widening the comparison time window resolved 33.6{\%} of cases with discordant indications of calcineurin inhibitor and/or antimetabolite use in claims compared with other data sources. Conclusions: This analysis supports the accuracy of the three sources of data for description of nonsteroid immunosuppression after kidney transplantation. Given the current strategic focus on reducing collection of data, use of alternative measures of immunosuppression exposure is appropriate and will assume greater importance.",
author = "Buchanan, {Paula M.} and Schnitzler, {Mark A.} and Daniel Brennan and Nino Dzebisashvili and Willoughby, {Lisa M.} and David Axelrod and Salvalaggio, {Paolo R.} and Abbott, {Kevin C.} and Burroughs, {Thomas E.} and Lentine, {Krista L.}",
year = "2008",
month = "1",
day = "1",
doi = "10.2215/CJN.02790707",
language = "English (US)",
volume = "3",
pages = "117--124",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "1",

}

TY - JOUR

T1 - Novel methods for tracking long-term maintenance immunosuppression regimens

AU - Buchanan, Paula M.

AU - Schnitzler, Mark A.

AU - Brennan, Daniel

AU - Dzebisashvili, Nino

AU - Willoughby, Lisa M.

AU - Axelrod, David

AU - Salvalaggio, Paolo R.

AU - Abbott, Kevin C.

AU - Burroughs, Thomas E.

AU - Lentine, Krista L.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - Background and objectives: Accurate assessment of the use of immunosuppressive medications is vital for observational analyses that are widely used in transplantation research. This study assessed the accuracy of three potential sources of maintenance immunosuppression data. Design, setting, participants, & measurements: This study investigated the agreement of immunosuppression information in directly linked electronic medical records for Medicare beneficiaries who received a kidney transplant at one center in 1998 through 2001, Organ Procurement and Transplantation Network (OPTN) survey data, and Medicare pharmacy claims. Pair-wise, interdata concordance (Κ) and percentage agreement statistics were used to compare immunosuppression regimens reported at discharge, and at 6 mo and 1 yr after transplantation in each data source. Results: Among 181 eligible participants, agreement between data sources for nonsteroid immunosuppression increased with time after transplantation. By 1-yr, concordance was excellent for calcineurin inhibitors and mycophenolate mofetil (Κ = 0.79 to 1.00), and very good for azathioprine (κ = 0.73 to 0.85). Similarly, percentage agreement at 1 yr was 94.9 to 100% for calcineurin inhibitors, 91.1 to 95.7% for mycophenolate mofetil, and 87.5 to 92.8% for azathioprine. Widening the comparison time window resolved 33.6% of cases with discordant indications of calcineurin inhibitor and/or antimetabolite use in claims compared with other data sources. Conclusions: This analysis supports the accuracy of the three sources of data for description of nonsteroid immunosuppression after kidney transplantation. Given the current strategic focus on reducing collection of data, use of alternative measures of immunosuppression exposure is appropriate and will assume greater importance.

AB - Background and objectives: Accurate assessment of the use of immunosuppressive medications is vital for observational analyses that are widely used in transplantation research. This study assessed the accuracy of three potential sources of maintenance immunosuppression data. Design, setting, participants, & measurements: This study investigated the agreement of immunosuppression information in directly linked electronic medical records for Medicare beneficiaries who received a kidney transplant at one center in 1998 through 2001, Organ Procurement and Transplantation Network (OPTN) survey data, and Medicare pharmacy claims. Pair-wise, interdata concordance (Κ) and percentage agreement statistics were used to compare immunosuppression regimens reported at discharge, and at 6 mo and 1 yr after transplantation in each data source. Results: Among 181 eligible participants, agreement between data sources for nonsteroid immunosuppression increased with time after transplantation. By 1-yr, concordance was excellent for calcineurin inhibitors and mycophenolate mofetil (Κ = 0.79 to 1.00), and very good for azathioprine (κ = 0.73 to 0.85). Similarly, percentage agreement at 1 yr was 94.9 to 100% for calcineurin inhibitors, 91.1 to 95.7% for mycophenolate mofetil, and 87.5 to 92.8% for azathioprine. Widening the comparison time window resolved 33.6% of cases with discordant indications of calcineurin inhibitor and/or antimetabolite use in claims compared with other data sources. Conclusions: This analysis supports the accuracy of the three sources of data for description of nonsteroid immunosuppression after kidney transplantation. Given the current strategic focus on reducing collection of data, use of alternative measures of immunosuppression exposure is appropriate and will assume greater importance.

UR - http://www.scopus.com/inward/record.url?scp=38749089465&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=38749089465&partnerID=8YFLogxK

U2 - 10.2215/CJN.02790707

DO - 10.2215/CJN.02790707

M3 - Article

C2 - 18077785

AN - SCOPUS:38749089465

VL - 3

SP - 117

EP - 124

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

IS - 1

ER -