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Background <p>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.</p> Methods <p>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.</p> Results <p>Three distinct AKI-1 subphenotypes are identified. Patients in Subphenotype C (<i>n</i> = 5,378; 10.0%) exhibit a higher proportion of abnormal values across clinical indicators compared to those in Subphenotypes A (<i>n</i> = 27,049; 50.5%) and B (<i>n</i> = 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.</p> Conclusions <p>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.</p>

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Clustering analysis of multi-site electronic health records reveals distinct subphenotypes in stage-1 acute kidney injury

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月3日

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  • Deyi Li,
  • Ho Yin Chan,
  • Alan S. L. Yu,
  • John A. Kellum,
  • Dana Y. Fuhrman,
  • Elizabeth A. Chrischilles,
  • Lindsay G. Cowell,
  • Sravani Chandaka,
  • Jacob Kean,
  • Kathleen M. McTigue,
  • Abu Saleh Mohammad Mosa,
  • Bradley Taylor,
  • Lemuel R. Waitman,
  • Mahanaz Syed,
  • Yong Hu,
  • Mei Liu

摘要

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.