A machine learning framework for identifying phenotypes in chronic kidney disease

Abstract

Identifying meaningful patient phenotypes is a cornerstone of data-driven healthcare, enabling risk stratification, resource allocation, and the design of personalized care strategies. Achieving this requires robust analytical methods that can uncover hidden structure in high-dimensional clinical data while ensuring stability and interpretability of results. In this study, we present a machine learning framework for phenotypic clustering that combines partition-based ($k$-means) and probabilistic (latent class analysis, LCA) approaches. By comparing subgroup assignments across these complementary methods, the framework provides an internal validation of clustering assignments. Rather than relying on a single method, the framework validates subgroup assignments through cross-method agreement, strengthening confidence in the robustness of the identified phenotypes and their utility for decision support. We apply the proposed framework to patients with chronic kidney disease (CKD) stratified by prior history of acute kidney injury (AKI), illustrating its value in uncovering population-level heterogeneity. While the mechanisms linking AKI to CKD phenotypic patterns remain poorly understood historically, this study investigates CKD trajectories in patients with and without prior AKI and identifies key phenotypic patterns. The analysis revealed consistent phenotypic structures, with over 80% agreement between the two clustering approaches. Distinct phenotypic patterns emerged between the AKI and non-AKI cohorts, with cardiovascular conditions consistently dominating in both groups. These findings demonstrate how stratified clustering can uncover risk signatures that traditional CKD staging systems may overlook. By combining complementary clustering algorithms, the framework strengthens the analytic foundation of phenotyping studies. Moreover, it enables the design of phenotype specific care pathways such as cluster aware monitoring panels and tailored coordination strategies, thus underscoring the broader potential of data-driven analytics to advance personalized medicine and healthcare decision support.