A Method for Characterizing Disease Progression from Acute Kidney Injury to Chronic Kidney Disease
This work addresses the problem of early CKD detection for AKI patients, offering a data-driven approach to support clinical decision-making, though it is incremental as it applies existing methods like clustering and multi-state modeling to new data.
The study tackled the challenge of identifying acute kidney injury (AKI) patients at high risk of developing chronic kidney disease (CKD) by using electronic health record data to dynamically track clinical evolution, identifying 15 distinct post-AKI states with varying CKD probabilities, and finding that 17% of 20,699 AKI patients developed CKD.
Patients 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. Post-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. Of 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. This 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.