Testing Causal Explanations: A Case Study for Understanding the Effect of Interventions on Chronic Kidney Disease
This work addresses the challenge of using observational data to inform healthcare delivery for chronic kidney disease patients, though it is incremental as it combines existing methods like regression discontinuity and Bayesian Networks.
The researchers tackled the problem of evaluating clinical interventions for chronic kidney disease (CKD) by developing a methodology using real-world electronic health record data from over two million individuals, applying regression discontinuity and dynamic Bayesian Networks to analyze associational and causal relationships, with results showing eGFR as the most influential variable in causal analysis.
Randomized controlled trials (RCTs) are the standard for evaluating the effectiveness of clinical interventions. To address the limitations of RCTs on real-world populations, we developed a methodology that uses a large observational electronic health record (EHR) dataset. Principles of regression discontinuity (rd) were used to derive randomized data subsets to test expert-driven interventions using dynamic Bayesian Networks (DBNs) do-operations. This combined method was applied to a chronic kidney disease (CKD) cohort of more than two million individuals and used to understand the associational and causal relationships of CKD variables with respect to a surrogate outcome of >=40% decline in estimated glomerular filtration rate (eGFR). The associational and causal analyses depicted similar findings across DBNs from two independent healthcare systems. The associational analysis showed that the most influential variables were eGFR, urine albumin-to-creatinine ratio, and pulse pressure, whereas the causal analysis showed eGFR as the most influential variable, followed by modifiable factors such as medications that may impact kidney function over time. This methodology demonstrates how real-world EHR data can be used to provide population-level insights to inform improved healthcare delivery.