ArticleCommunications medicine2025
Clustering analysis of multi-site electronic health records reveals distinct subphenotypes in stage-1 acute kidney injury.
Article in Communications medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute Kidney Injury (AKI) can adversely affect multiple organ systems, including the heart, brain, and immune system. Stage 1 AKI (AKI-1), although mild in clinical presentation, constitutes a substantial subset of AKI patients with heterogeneous outcomes, warranting further investigation into its subphenotypes.
methodsWe performed clustering analysis on seven-day serum creatinine (SCr) trajectories preceding AKI-1 onset in 53,565 AKI-1 patients (aged 18-89 years; 55.57% male) across eight academic hospitals. Each AKI-1 patient was matched to a non-AKI counterpart to evaluate how different AKI-1 subphenotypes influence clinical indicators and outcomes.
resultsThree distinct AKI-1 subphenotypes are identified. Patients in Subphenotype C (n = 5,378; 10.0%) exhibit a higher proportion of abnormal values across clinical indicators compared to those in Subphenotypes A (n = 27,049; 50.5%) and B (n = 21,138; 39.5%). Subphenotype C is associated with significantly higher odds ratios (ORs) for in-hospital, 30-day, and one-year all-cause mortality relative to Subphenotypes A and B. Conversely, Subphenotype B exhibits a higher susceptibility to developing chronic kidney disease (CKD) within one year after discharge following AKI-1, compared to both Subphenotypes A and C, after adjustment for baseline SCr levels. All AKI-1 subphenotypes are associated with significantly elevated risks of all-cause mortality and the need for dialysis or renal replacement therapy (RRT) compared to their respective non-AKI counterparts.
conclusionsThis study reveals substantial heterogeneity in clinical indicators and outcomes within AKI-1. Future research focusing on these subphenotypes may pave the way for more personalized and targeted interventions for patients with AKI-1.
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