ArticleJournal of biomedical informatics2025
A method for characterizing disease progression from acute kidney injury to chronic kidney disease.
Article in Journal of biomedical informatics, 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
objectivePatients with acute kidney injury (AKI) are at high risk of developing chronic kidney disease (CKD), but identifying those at greatest risk remains challenging. We used electronic health record (EHR) data to dynamically track AKI patients' clinical evolution and characterize AKI-to-CKD progression.
methodsPost-AKI clinical states were identified by clustering patient vectors derived from longitudinal medical codes and creatinine measurements. Transition probabilities between states and progression to CKD were estimated using multi-state modeling. After identifying common post-AKI trajectories, CKD risk factors in AKI subpopulations were identified through survival analysis.
resultsOf 20,699 patients with AKI at admission, 3,491 (17 %) developed CKD. We identified fifteen distinct post-AKI states, each with different probabilities of CKD development. Most patients (75 %, n = 15,607) remained in a single state or made only one transition during the study period. Both established (e.g., AKI severity, diabetes, hypertension, heart failure, liver disease) and novel CKD risk factors, with their impact varying across these clinical states.
conclusionThis study demonstrates a data-driven approach for identifying high-risk AKI patients, supporting the development of decision-support tools for early CKD detection and intervention.
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