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Urea and Electrolytes (M1)

S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Aschroft

Type
Biomarker
ID
PH662
Version ID
1324
Data Sources
Valid event data range
Start - 01/02/2013
Sex
Female, Male
Agreement Date
2015-11-03
Coding system
Read codes v2
Tags /Collections
ClinicalCodes Repository Phenotype Library

Definition

Study question:

What is the prevalence of different types of potentially hazardous prescribing in general practice in the United Kingdom, and what is the variation between practices?

Methods:

A cross sectional study included all adult patients potentially at risk of a prescribing or monitoring error defined by a combination of diagnoses and prescriptions in 526 general practices contributing to the Clinical Practice Research Datalink (CPRD) up to 1 April 2013. Primary outcomes were the prevalence of potentially hazardous prescriptions of anticoagulants, anti-platelets, NSAIDs, β blockers, glitazones, metformin, digoxin, antipsychotics, combined hormonal contraceptives, and oestrogens and monitoring by blood test less frequently than recommended for patients with repeated prescriptions of angiotensin converting enzyme inhibitors and loop diuretics, amiodarone, methotrexate, lithium, or warfarin.

Study answer and limitations:

49 927 of 949 552 patients at risk triggered at least one prescribing indicator (5.26%, 95% confidence interval 5.21% to 5.30%) and 21 501 of 182 721 (11.8%, 11.6% to 11.9%) triggered at least one monitoring indicator. The prevalence of different types of potentially hazardous prescribing ranged from almost zero to 10.2%, and for inadequate monitoring ranged from 10.4% to 41.9%. Older patients and those prescribed multiple repeat medications had significantly higher risks of triggering a prescribing indicator whereas younger patients with fewer repeat prescriptions had significantly higher risk of triggering a monitoring indicator. There was high variation between practices for some indicators. Though prescribing safety indicators describe prescribing patterns that can increase the risk of harm to the patient and should generally be avoided, there will always be exceptions where the indicator is clinically justified. Furthermore there is the possibility that some information is not captured by CPRD for some practices—for example, INR results in patients receiving warfarin.

What this study adds:

The high prevalence for certain indicators emphasises existing prescribing risks and the need for their appropriate consideration within primary care, particularly for older patients and those taking multiple medications. The high variation between practices indicates potential for improvement through targeted practice level intervention.

Publications

  • S Jill Stocks, Evangelos Kontopantelis, Artur Akbarov, Sarah Rodgers, Anthony J Avery, Darren M Ashcroft, Examining variations in prescribing safety in UK general practice cross sectional study using the Clinical Practice Research Datalink. BMJ, 351(h5501), 2015.

Clinical Code List

Rows: 89
Code Description Entity type Category Coding System (Read)
4412000 Urea and electrolytes normal res25: M1_U&E test Read
4412100 Urea and electrolytes abnormal res25: M1_U&E test Read
44I..00 Serum electrolytes res25: M1_U&E test Read
44I0.00 res25: M1_U&E test Read
44I1.00 Blood sent for electrolytes res25: M1_U&E test Read
44I2.00 Electrolytes normal res25: M1_U&E test Read
44I3.00 Electrolytes abnormal res25: M1_U&E test Read
44I4.00 Serum potassium res25: M1_U&E test Read
44I4000 Normal serum potassium level res25: M1_U&E test Read
44I4100 Raised serum potassium level res25: M1_U&E test Read
44I4200 Low serum potassium level res25: M1_U&E test Read
44I5.00 Serum sodium res25: M1_U&E test Read
44I5000 Serum sodium level normal res25: M1_U&E test Read
44I5100 Serum sodium level abnormal res25: M1_U&E test Read
44I6.00 Serum chloride res25: M1_U&E test Read
44I6000 Serum chloride level normal res25: M1_U&E test Read
44I6100 Serum chloride level abnormal res25: M1_U&E test Read
44I7.00 Serum bicarbonate res25: M1_U&E test Read
44I7000 Serum bicarbonate level normal res25: M1_U&E test Read
44I7100 Serum bicarbonate level abnormal res25: M1_U&E test Read
44I8.00 Serum calcium res25: M1_U&E test Read
44I8000 Normal serum calcium level res25: M1_U&E test Read
44I8100 Raised serum calcium level res25: M1_U&E test Read
44I9.00 Serum inorganic phosphate res25: M1_U&E test Read
44I9000 Serum phosphate level normal res25: M1_U&E test Read
44I9100 Serum phosphate level abnormal res25: M1_U&E test Read
44IA.00 Plasma anion gap res25: M1_U&E test Read
44IB.00 Serum anion gap res25: M1_U&E test Read
44IC.00 Corrected serum calcium level res25: M1_U&E test Read
44IC.11 Adjusted serum calcium level res25: M1_U&E test Read
44ID.00 Serum ionised calcium level res25: M1_U&E test Read
44IE.00 Serum ionized calcium (pH 7.4) level res25: M1_U&E test Read
44IF.00 Urine chromatography res25: M1_U&E test Read
44IZ.00 Serum electrolytes NOS res25: M1_U&E test Read
44J..00 Blood urea/renal function res25: M1_U&E test Read
44J..11 Urea - blood res25: M1_U&E test Read
44J..12 Urea and electrolytes res25: M1_U&E test Read
44J..13 Serum urea level res25: M1_U&E test Read
44J1.00 Blood urea normal res25: M1_U&E test Read
44J2.00 Blood urea abnormal res25: M1_U&E test Read
44J3.00 Serum creatinine res25: M1_U&E test Read
44J3000 Serum creatinine abnormal res25: M1_U&E test Read
44J3100 Serum creatinine low res25: M1_U&E test Read
44J3200 Serum creatinine normal res25: M1_U&E test Read
44J3300 Serum creatinine raised res25: M1_U&E test Read
44J3z00 Serum creatinine NOS res25: M1_U&E test Read
44J4.00 Serum osmolality res25: M1_U&E test Read
44J5.00 Renal profile res25: M1_U&E test Read
44J6.00 Albumin excretion rate res25: M1_U&E test Read
44J7.00 Albumin / creatinine ratio res25: M1_U&E test Read
44J8.00 Blood urea res25: M1_U&E test Read
44J8.11 Urea - blood res25: M1_U&E test Read
44J9.00 Serum urea level res25: M1_U&E test Read
44JA.00 Plasma urea level res25: M1_U&E test Read
44JB.00 Urea and electrolytes res25: M1_U&E test Read
44JC.00 Corrected plasma creatinine level res25: M1_U&E test Read
44JD.00 Corrected serum creatinine level res25: M1_U&E test Read
44JE.00 Peritoneal equilibration test res25: M1_U&E test Read
44JF.00 Plasma creatinine level res25: M1_U&E test Read
44JG.00 Overnight albumin excretion rate res25: M1_U&E test Read
44JH.00 Plasma osmolality res25: M1_U&E test Read
44JZ.00 Blood urea/renal function NOS res25: M1_U&E test Read
44h..00 Blood electrolyte levels res25: M1_U&E test Read
44h0.00 Blood potassium level res25: M1_U&E test Read
44h1.00 Blood sodium level res25: M1_U&E test Read
44h2.00 Blood chloride level res25: M1_U&E test Read
44h3.00 Blood bicarbonate level res25: M1_U&E test Read
44h4.00 Blood calcium level res25: M1_U&E test Read
44h5.00 Blood inorganic phosphate level res25: M1_U&E test Read
44h6.00 Plasma sodium level res25: M1_U&E test Read
44h7.00 Plasma calcium level res25: M1_U&E test Read
44h8.00 Plasma potassium level res25: M1_U&E test Read
44h9.00 Plasma corrected calcium level res25: M1_U&E test Read
44hA.00 Blood total carbon dioxide (calculated) res25: M1_U&E test Read
44hB.00 Actual bicarbonate level res25: M1_U&E test Read
44hC.00 Standard bicarbonate level res25: M1_U&E test Read
44hD.00 Blood ionised calcium level res25: M1_U&E test Read
44i..00 Plasma electrolyte levels res25: M1_U&E test Read
44i0.00 Plasma bicarbonate level res25: M1_U&E test Read
44i1.00 Plasma chloride level res25: M1_U&E test Read
44i2.00 Plasma inorganic phosphate level res25: M1_U&E test Read
4513 Creatinine clearance-glom filt res25: M1_U&E test Read
4513.11 Creatinine clearance res25: M1_U&E test Read
451E.00 GFR calculated abbreviated MDRD res25: M1_U&E test Read
451F.00 Glomerular filtration rate res25: M1_U&E test Read
451G.00 GFR calculated abbreviated MDRD adj for African Americ orign res25: M1_U&E test Read
4Q40.00 Creatinine level res25: M1_U&E test Read
4Q42.00 Potassium level res25: M1_U&E test Read
4Q43.00 Sodium level res25: M1_U&E test Read

API

To Export Phenotype Details:

Format API
XML site_root/api/v1/public/phenotypes/PH662/version/1324/detail/?format=xml
JSON site_root/api/v1/public/phenotypes/PH662/version/1324/detail/?format=json
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get details of phenotype

details = get_phenotype_detail_by_version('PH662', '1324', api_client=client)

To Export Phenotype Code List:

Format API
XML site_root/api/v1/public/phenotypes/PH662/version/1324/export/codes/?format=xml
JSON site_root/api/v1/public/phenotypes/PH662/version/1324/export/codes/?format=json
CSV site_root/phenotypes/PH662/version/1324/export/codes/
R Package

# Download here

library(ConceptLibraryClient)


# Connect to API

client = connect_to_API(public=TRUE)


# Get codelists of phenotype

codelists = get_phenotype_code_list('PH662', '1324', api_client=client)

Version History

Version
ID
Name Owner Publish date
1324 Urea and Electrolytes (M1) ieuan.scanlon 2021-10-06 currently shown

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