{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T14:45:31Z","timestamp":1772808331785,"version":"3.50.1"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2015,3,1]],"date-time":"2015-03-01T00:00:00Z","timestamp":1425168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Objective The aim of this study is to analyze and visualize the polymorbidity associated with chronic kidney disease (CKD). The study shows diseases associated with CKD before and after CKD diagnosis in a time-evolutionary type visualization.<\/jats:p><jats:p>Materials and Methods Our sample data came from a population of one million individuals randomly selected from the Taiwan National Health Insurance Database, 1998 to 2011. From this group, those patients diagnosed with CKD were included in the analysis. We selected 11 of the most common diseases associated with CKD before its diagnosis and followed them until their death or up to 2011. We used a Sankey-style diagram, which quantifies and visualizes the transition between pre- and post-CKD states with various lines and widths. The line represents groups and the width of a line represents the number of patients transferred from one state to another.<\/jats:p><jats:p>Results The patients were grouped according to their states: that is, diagnoses, hemodialysis\/transplantation procedures, and events such as death. A Sankey diagram with basic zooming and planning functions was developed that temporally and qualitatively depicts they had amid change of comorbidities occurred in pre- and post-CKD states.<\/jats:p><jats:p>Discussion This represents a novel visualization approach for temporal patterns of polymorbidities associated with any complex disease and its outcomes. The Sankey diagram is a promising method for visualizing complex diseases and exploring the effect of comorbidities on outcomes in a time-evolution style.<\/jats:p><jats:p>Conclusions This type of visualization may help clinicians foresee possible outcomes of complex diseases by considering comorbidities that the patients have developed.<\/jats:p>","DOI":"10.1093\/jamia\/ocu044","type":"journal-article","created":{"date-parts":[[2015,4,6]],"date-time":"2015-04-06T23:02:21Z","timestamp":1428361341000},"page":"290-298","source":"Crossref","is-referenced-by-count":23,"title":["A novel tool for visualizing chronic kidney disease associated polymorbidity: a 13-year cohort study in Taiwan"],"prefix":"10.1093","volume":"22","author":[{"given":"Chih-Wei","family":"Huang","sequence":"first","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"}]},{"given":"Shabbir","family":"Syed-Abdul","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"}]},{"given":"Wen-Shan","family":"Jian","sequence":"additional","affiliation":[{"name":"School of Health Care Administration, Taipei Medical University, Taipei, Taiwan"},{"name":"Faculty of Health Sciences, Macau University of Science and Technology, Macau"}]},{"given":"Usman","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"}]},{"given":"Phung-Anh (Alex)","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"}]},{"given":"Peisan","family":"Lee","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"},{"name":"Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan"}]},{"given":"Shen-Hsien","family":"Lin","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"}]},{"given":"Wen-Ding","family":"Hsu","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"},{"name":"Department of Nephrology, New Taipei City Hospital, New Taipei City Government, Taipei, Taiwan"}]},{"given":"Mai-Szu","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan"},{"name":"School of Medicine, Taipei Medical University, Taipei, Taiwan"}]},{"given":"Chun-Fu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of California-Davis, California, USA"}]},{"given":"Kwan-Liu","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of California-Davis, California, USA"}]},{"given":"Yu-Chuan (Jack)","family":"Li","sequence":"additional","affiliation":[{"name":"Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan"},{"name":"Department of Dermatology, Wan-Fang Hospital, Taipei, Taiwan."}]}],"member":"286","published-online":{"date-parts":[[2015,3,26]]},"reference":[{"issue":"6","key":"2021010611500989100_ocu044-B1","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1038\/nrg3208","article-title":"Mining electronic health records: towards better research applications and clinical care","volume":"13","author":"Jensen","year":"2012","journal-title":"Nat Rev Genet."},{"issue":"1","key":"2021010611500989100_ocu044-B2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1136\/amiajnl-2012-001145","article-title":"Next-generation phenotyping of electronic health records","volume":"20","author":"Hripcsak","year":"2013","journal-title":"J Am Med Informat Assoc."},{"issue":"3","key":"2021010611500989100_ocu044-B3","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/j.cmpb.2013.09.001","article-title":"The relationship between usage intention and adoption of electronic health records at primary care clinics","volume":"112","author":"Iqbal","year":"2013","journal-title":"Comput Meth Prog Biomed."},{"issue":"2","key":"2021010611500989100_ocu044-B4","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1016\/j.cmpb.2013.10.005","article-title":"Empowering village doctors and enhancing rural healthcare using cloud computing in a rural area of mainland China","volume":"113","author":"Lin","year":"2014","journal-title":"Comput Meth Prog Biomed."},{"issue":"2","key":"2021010611500989100_ocu044-B5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s11576-013-0350-x","article-title":"Big data","volume":"55","author":"Buhl","year":"2013","journal-title":"Wirtschaftsinformatik."},{"issue":"1","key":"2021010611500989100_ocu044-B6","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2196\/medinform.2913","article-title":"Big data and clinicians: a review on the state of the science","volume":"2","author":"Wang","year":"2014","journal-title":"JMIR Med Informat."},{"key":"2021010611500989100_ocu044-B7","volume-title":"The Importance of \u2018Big Data\u2019: A Definition","author":"Beyer","year":"2012"},{"issue":"1","key":"2021010611500989100_ocu044-B8","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.cmpb.2013.07.004","article-title":"Developing a data mining approach to investigate association between physician prescription and patient outcome - a study on re-hospitalization in Stevens-Johnson Syndrome","volume":"112","author":"Ou-Yang","year":"2013","journal-title":"Comput Meth Prog Biomed."},{"issue":"2","key":"2021010611500989100_ocu044-B9","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1016\/j.cmpb.2013.05.006","article-title":"Influenza vaccination and reduction in risk of ischemic heart disease among chronic obstructive pulmonary elderly","volume":"111","author":"Huang","year":"2013","journal-title":"Comput Meth Prog Biomed."},{"issue":"9631","key":"2021010611500989100_ocu044-B10","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1016\/S0140-6736(08)60952-6","article-title":"All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan","volume":"371","author":"Wen","year":"2008","journal-title":"Lancet."},{"issue":"1","key":"2021010611500989100_ocu044-B11","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1053\/j.ajkd.2006.10.007","article-title":"Epidemiological features of CKD in Taiwan","volume":"49","author":"Kuo","year":"2007","journal-title":"Am J Kidney Dis."},{"issue":"1","key":"2021010611500989100_ocu044-B12","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1186\/1471-2458-8-117","article-title":"Prevalence of chronic kidney disease in population-based studies: systematic review","volume":"8","author":"Zhang","year":"2008","journal-title":"BMC Public Health."},{"issue":"1","key":"2021010611500989100_ocu044-B13","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1186\/1471-2458-8-221","article-title":"Prevalence of comorbidity of chronic diseases in Australia","volume":"8","author":"Caughey","year":"2008","journal-title":"BMC Public Health."},{"issue":"4","key":"2021010611500989100_ocu044-B14","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1111\/j.1523-1755.2004.00894.x","article-title":"The burden of kidney disease: improving global outcomes","volume":"66","author":"Eknoyan","year":"2004","journal-title":"Kidney Int."},{"issue":"12","key":"2021010611500989100_ocu044-B15","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1038\/ki.2011.368","article-title":"The contribution of chronic kidney disease to the global burden of major noncommunicable diseases","volume":"80","author":"Couser","year":"2011","journal-title":"Kidney Int."},{"key":"2021010611500989100_ocu044-B16","doi-asserted-by":"crossref","first-page":"iii32","DOI":"10.1093\/ndt\/gfs113","article-title":"The impact of CKD identification in large countries: the burden of illness","volume":"27","author":"Jha","year":"2012","journal-title":"Nephrol Dial Transpl."},{"key":"2021010611500989100_ocu044-B17","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1440-1797.2010.01304.x","article-title":"Epidemiology, impact and preventive care of chronic kidney disease in Taiwan","volume":"15","author":"Hwang","year":"2010","journal-title":"Nephrology."},{"issue":"6","key":"2021010611500989100_ocu044-B18","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1111\/j.1523-1755.2005.00365.x","article-title":"Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO)","volume":"67","author":"Levy","year":"2005","journal-title":"Kidney Int."},{"issue":"1","key":"2021010611500989100_ocu044-B19","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1159\/000180580","article-title":"Prediction of creatinine clearance from serum creatinine","volume":"16","author":"Cockcroft","year":"1976","journal-title":"Nephron."},{"issue":"4","key":"2021010611500989100_ocu044-B20","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1001\/archinte.167.4.374","article-title":"SCreening for Occult REnal Disease (SCORED): a simple prediction model for chronic kidney disease","volume":"167","author":"Bang","year":"2007","journal-title":"Arch Intern Med."},{"issue":"4","key":"2021010611500989100_ocu044-B21","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1053\/j.ajkd.2007.12.017","article-title":"CKD and cardiovascular disease in screened high-risk volunteer and general populations: the Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey (NHANES) 1999-2004","volume":"51","author":"McCullough","year":"2008","journal-title":"Am J Kidney Dis."},{"issue":"9","key":"2021010611500989100_ocu044-B22","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med."},{"issue":"1","key":"2021010611500989100_ocu044-B23","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1111\/j.1530-9290.2008.00004.x","article-title":"The Sankey diagram in energy and material flow management","volume":"12","author":"Schmidt","year":"2008","journal-title":"JI Ind Ecol."},{"issue":"12","key":"2021010611500989100_ocu044-B24","doi-asserted-by":"crossref","first-page":"2659","DOI":"10.1109\/TVCG.2012.225","article-title":"Exploring flow, factors, and outcomes of temporal event sequences with the outflow visualization","volume":"18","author":"Wongsuphasawat","year":"2012","journal-title":"IEEE T Vis Comput GR."},{"issue":"6","key":"2021010611500989100_ocu044-B25","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1109\/TVCG.2011.108","article-title":"Model-driven design for the visual analysis of heterogeneous data","volume":"18","author":"Streit","year":"2012","journal-title":"IEEE T Vis Comput GR."},{"key":"2021010611500989100_ocu044-B26","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1109\/INFVIS.2005.1532152","article-title":"Interactive sankey diagrams","volume-title":"IEEE Symposium on Information Visualization, 2005 (INFOVIS 2005)","author":"Riehmann","year":"2005"},{"issue":"4","key":"2021010611500989100_ocu044-B27","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1109\/TVCG.2006.76","article-title":"Parallel sets: interactive exploration and visual analysis of categorical data","volume":"12","author":"Kosara","year":"2006","journal-title":"IEEE T Vis Comput GR."},{"key":"2021010611500989100_ocu044-B28","article-title":"Leveraging domain knowledge to facilitate visual exploration of large population datasets","volume-title":"AMIA Annual Symposium Proceedings","author":"Hsu","year":"2013"},{"issue":"3","key":"2021010611500989100_ocu044-B29","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.cmpb.2013.12.013","article-title":"Stereoscopic visualization of laparoscope image using depth information from 3D model","volume":"113","author":"Kumar","year":"2014","journal-title":"Comput Meth Prog Biomed."},{"issue":"3","key":"2021010611500989100_ocu044-B30","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.cmpb.2013.01.007","article-title":"A new surveillance and spatio-temporal visualization tool SIMID: SIMulation of infectious diseases using random networks and GIS","volume":"110","author":"Ramirez-Ramirez","year":"2013","journal-title":"Comput Meth Prog Biomed."},{"key":"2021010611500989100_ocu044-B31","article-title":"Outflow: visualizing patient flow by symptoms and outcome","volume-title":"IEEE VisWeek Workshop on Visual Analytics in Healthcare","author":"Wongsuphasawat","year":"2011"},{"issue":"26","key":"2021010611500989100_ocu044-B32","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1056\/NEJM197112232852601","article-title":"The natural history of congestive heart failure: the Framingham study","volume":"285","author":"McKee","year":"1971","journal-title":"N Engl J Med."},{"issue":"2","key":"2021010611500989100_ocu044-B33","article-title":"Disease universe: visualisation of population-wide disease-wide associations. Advances in Systems Science and Applications","volume":"14","author":"Moldovan","year":"2013"},{"issue":"3","key":"2021010611500989100_ocu044-B34","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/j.cmpb.2014.08.008","article-title":"Automated estimation of disease recurrence in head and neck cancer using routine healthcare data","volume":"117","author":"Ricketts","year":"2014","journal-title":"Comput Meth Prog Biomed."},{"issue":"1","key":"2021010611500989100_ocu044-B35","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.cmpb.2013.02.007","article-title":"A web-based system for clinical decision support and knowledge maintenance for deterioration monitoring of hemato-oncological patients","volume":"111","author":"Wicht","year":"2013","journal-title":"Comput Meth Prog Biomed."},{"issue":"5","key":"2021010611500989100_ocu044-B36","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1093\/intqhc\/mzu063","article-title":"Can preventable adverse events be predicted among hospitalized older patients? The development and validation of a predictive model","volume":"26","author":"Van De Steeg","year":"2014","journal-title":"Int J Qual Health Care."},{"issue":"6","key":"2021010611500989100_ocu044-B37","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1093\/intqhc\/mzt065","article-title":"High-quality chronic care delivery improves experiences of chronically ill patients receiving care","volume":"25","author":"Cramm","year":"2013","journal-title":"Int J Qual Health Care."},{"issue":"12","key":"2021010611500989100_ocu044-B38","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.47102\/annals-acadmedsg.V38N12p1095","article-title":"Drug use and dosing in chronic kidney disease","volume":"38","author":"Hassan","year":"2009","journal-title":"Ann Acad Med Singapore."},{"issue":"1","key":"2021010611500989100_ocu044-B39","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1056\/NEJMoa1114248","article-title":"Estimating glomerular filtration rate from serum creatinine and cystatin C","volume":"367","author":"Inker","year":"2012","journal-title":"N Engl J Med."},{"issue":"3","key":"2021010611500989100_ocu044-B40","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1038\/nrclinonc.2010.227","article-title":"Predictive, personalized, preventive, participatory (P4) cancer medicine","volume":"8","author":"Hood","year":"2011","journal-title":"Nat Rev Clin Oncol."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/2\/290\/34931373\/ocu044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/22\/2\/290\/34931373\/ocu044.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,9]],"date-time":"2023-08-09T07:12:28Z","timestamp":1691565148000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/22\/2\/290\/698106"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,3,1]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2015,3,26]]},"published-print":{"date-parts":[[2015,3,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocu044","relation":{},"ISSN":["1527-974X","1067-5027"],"issn-type":[{"value":"1527-974X","type":"electronic"},{"value":"1067-5027","type":"print"}],"subject":[],"published-other":{"date-parts":[[2015,3]]},"published":{"date-parts":[[2015,3,1]]}}}