A Method for Characterizing Disease Progression from Acute Kidney Injury to Chronic Kidney Disease

TL;DR

This study uses electronic health record data to track and analyze the progression from acute kidney injury to chronic kidney disease, identifying risk factors and clinical trajectories to aid early detection.

Contribution

It introduces a data-driven method to characterize post-AKI states and identify high-risk patients using clustering, multi-state modeling, and survival analysis.

Findings

17% of AKI patients developed CKD.

Fifteen distinct post-AKI states were identified.

Both known and novel risk factors were associated with CKD progression.

Abstract

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.