• Jui-Yi Chen, Chih-Chung Shiao, Jung-Hua Liu, Ching-Chun Su, Heng-Chih Pan, Tsao Chun-Hao, Wei-Ting Chu, Tao-Min Huang, Chun-Fu Lai, and Vin-Cent Wu.
• Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. Electronic address: kwuilus0101@gmail.com.
• J Formos Med Assoc. 2024 Oct 7.

BackgroundCertain patient subpopulations requiring dialysis initiation show varied survival rates and chances of ending renal replacement therapy (RRT). Consensus clustering can help identify these subgroups and their dialysis outcomes.MethodsThe study included patients who were over 18 years old with urine output above 400 ml per day and an estimated glomerular filtration rate over 15 ml/min/1.73 m2. They underwent acute RRT because of systemic demand-capacity imbalance. Using consensus clustering with 33 clinical variables and urea:creatinine ratio (UCR) to the variables to investigate the catabolic demand. Endpoints were all-cause mortality and being dialysis-free at 180-day follow-up after RRT initiation.ResultsOf 946 patients (mean 63 ± 17 years and 649 men, 68.6 %) three distinct phenotypes were identified. 509 (53.8%) patients died and 364 (38.5%) patients were weaned off dialysis. Cluster 2 showed better survival (60.23% vs. 53.18% [cluster 1] vs. 45.85% [cluster 3], P < 0.01) and higher possibility to be weaned off RRT (45.24% vs. 38.44% [cluster 1] vs. 31.62% [cluster 3], P < 0.01). High UCR had increased mortality (59.16% vs. 47.75%, P < 0.01) and a lower weaning rates (33.27%; 45.72%, P < .01). UCR with the clustering phenotype improved risk stratification.ConclusionsAmong critical patients undergoing RRT due to systemic demand-capacity imbalance, more than half of the patients died. We identified distinct phenotypes in demand-capacity imbalance in a heterogeneous cohort of patients initializing RRT. Additionally, we found that pre-dialysis UCR as a novel predictor for mortality and the likelihood of being dialysis-free.Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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