Journal article
Clustering analysis of multi-site electronic health records reveals distinct subphenotypes in stage-1 acute kidney injury
Communications medicine, Vol.5(1), 274
07/03/2025
DOI: 10.1038/s43856-025-00993-6
PMCID: PMC12229304
PMID: 40610745
Abstract
Background
Acute 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.
Methods
We 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.
Results
Three 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.
Conclusions
This 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.
Plain language summary
Stage 1 acute kidney injury (AKI-1) is the mildest form of sudden kidney damage, usually identified by a small rise in a blood waste marker called creatinine or a slight drop in urine output. Although AKI-1 may seem mild at first, it can still lead to serious consequences. This study investigated whether there are subtypes of AKI-1 that carry different health risks. Using hospital data from 53,565 patients, we grouped patients based on how their serum creatinine (kidney function biomarker) change over time, and found three distinct subtypes of AKI-1, each linked to different health outcomes. One subtype had a significantly higher risk of death, while another subtype was more likely to develop chronic kidney disease (CKD) after hospital discharge. These findings could help doctors provide more personalized care to patients with AKI-1.
Li et al. identify three subphenotypes of stage-1 Acute Kidney Injury based on serum creatinine trajectories prior to onset. These subphenotypes show distinct clinical profiles and outcomes, suggesting opportunities for more personalized stage-1 Acute Kidney Injury management.
Details
- Title: Subtitle
- Clustering analysis of multi-site electronic health records reveals distinct subphenotypes in stage-1 acute kidney injury
- Creators
- Deyi Li - University of FloridaHo Yin Chan - University of FloridaAlan S. L. Yu - University of Kansas Medical CenterJohn A. Kellum - University of PittsburghDana Y. Fuhrman - Children's Hospital of PittsburghElizabeth A. Chrischilles - University of IowaLindsay G. Cowell - The University of Texas Southwestern Medical CenterSravani Chandaka - University of Kansas Medical CenterJacob Kean - University of UtahKathleen M. McTigue - University of PittsburghAbu Saleh Mohammad Mosa - University of MissouriBradley Taylor - Medical College of WisconsinLemuel R. Waitman - University of MissouriMahanaz Syed - The University of Texas Health Science Center at San AntonioYong Hu - Jinan UniversityMei Liu - University of Florida
- Resource Type
- Journal article
- Publication Details
- Communications medicine, Vol.5(1), 274
- DOI
- 10.1038/s43856-025-00993-6
- PMID
- 40610745
- PMCID
- PMC12229304
- NLM abbreviation
- Commun Med (Lond)
- ISSN
- 2730-664X
- eISSN
- 2730-664X
- Publisher
- Nature Publishing Group UK
- Grant note
- 2444044 / National Science Foundation (NSF) (https://doi.org/10.13039/100000001) R01DK116986 / U.S. Department of Health & Human Services | NIH | National Institute of Diabetes and Digestive and Kidney Diseases (National Institute of Diabetes & Digestive & Kidney Diseases) (https://doi.org/10.13039/100000062)
- Language
- English
- Date published
- 07/03/2025
- Academic Unit
- Pharmacy; Epidemiology
- Record Identifier
- 9984843245302771
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