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. 2024 May 28;13(11):3159.
doi: 10.3390/jcm13113159.

Unsupervised Cluster Analysis in Patients with Cardiorenal Syndromes: Identifying Vascular Aspects

Jean-Baptiste de Freminville  1   2 , Jean-Michel Halimi  3   4   5 , Valentin Maisons  3   6 , Guillaume Goudot  2   7 , Arnaud Bisson  4   8 , Denis Angoulvant  4   8 , Laurent Fauchier  4   8
Affiliations

Unsupervised Cluster Analysis in Patients with Cardiorenal Syndromes: Identifying Vascular Aspects

Jean-Baptiste de Freminville et al. J Clin Med. .

Abstract

Background/Objectives: Cardiorenal syndrome (CRS) is a disorder of the heart and kidneys, with one type of organ dysfunction affecting the other. The pathophysiology is complex, and its actual description has been questioned. We used clustering analysis to identify clinically relevant phenogroups among patients with CRS. Methods: Data for patients admitted from 1 January 2012 to 31 December 2012 were collected from the French national medico-administrative database. Patients with a diagnosis of heart failure and chronic kidney disease and at least 5 years of follow-up were included. Results: In total, 13,665 patients were included and four clusters were identified. Cluster 1 could be described as the vascular-diabetes cluster. It comprised 1930 patients (14.1%), among which 60% had diabetes, 94% had coronary artery disease (CAD), and 80% had peripheral artery disease (PAD). Cluster 2 could be described as the vascular cluster. It comprised 2487 patients (18.2%), among which 33% had diabetes, 85% had CAD, and 78% had PAD. Cluster 3 could be described as the metabolic cluster. It comprised 2163 patients (15.8%), among which 87% had diabetes, 67% dyslipidemia, and 62% obesity. Cluster 4 comprised 7085 patients (51.8%) and could be described as the low-vascular cluster. The vascular cluster was the only one associated with a higher risk of cardiovascular death (HR: 1.48 [1.32-1.66]). The metabolic cluster was associated with a higher risk of kidney replacement therapy (HR: 1.33 [1.17-1.51]). Conclusions: Our study supports a new classification of CRS based on the vascular aspect of pathophysiology differentiating microvascular or macrovascular lesions. These results could have an impact on patients' medical treatment.

Keywords: cardiorenal syndrome; chronic kidney disease; heart failure.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Cardiorenal syndrome connection.
Figure 2
Figure 2
Dendrogram generated by hierarchical clustering process showing the CRS clusters. The dendrogram graph is a visual representation of the hierarchical clustering process. Vertical lines are clusters that are joined together, and the position of the line on the scale indicates the distance at which the clusters are joined. Clusters are identified by different colors.
Figure 3
Figure 3
Flow chart.
Figure 4
Figure 4
Heatmap of baseline characteristics of patients with CRS according to patient clusters.
See this image and copyright information in PMC

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