{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:14:39Z","timestamp":1788243279798,"version":"build-2803163510"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000191","name":"Kidney Foundation of Canada","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000191","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intradialytic blood pressure variations are frequent and associated with poor clinical outcomes. However, the use of arbitrary, inconsistent diagnostic definitions limits cross-study comparability and hinders the development of evidence-based knowledge guiding management. This study aimed to bypass rigid, threshold-based diagnostic criteria using latent profile analysis, an unsupervised clustering method, to identify data-driven hemodynamic phenotypes in incident hemodialysis patients and explore their prognostic utility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We applied latent profile analysis to intradialytic hemodynamic time-series data from a retrospective cohort of incident maintenance hemodialysis patients from 2017 to 2022. Sixteen patient-level indicators capturing baseline hemodynamics were manually engineered. We established internal validity via cross-validation, identified baseline clinical predictors of profile membership, and assessed prognostic utility against standard diagnostic definitions using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A four-profile model was selected based on fit diagnostics and clinical interpretation and demonstrated cross-validation robustness. Profile 1 exhibited early nadirs with a late-session recovery. Profile 2 displayed a highly oscillatory pattern. Profile 3 demonstrated remarkable hemodynamic stability. Profile 4 featured frequent, unrecovered early nadirs. While results from the survival analyses were non-significant, profiles yielded divergent point estimates and demonstrated comparable discrimination and statistical fit to standard definition-based models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unsupervised clustering effectively uncovers distinct hemodynamic phenotypes, bypassing the limitations of rigid diagnostic thresholds. Data-driven profiling provides a rigorous taxonomy to improve personalized clinical decision-making and reduce heterogeneity in future interventional studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfag247","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:38:38Z","timestamp":1785843518000},"source":"Crossref","is-referenced-by-count":0,"title":["Identification of intradialytic hemodynamic phenotypes using latent profile analysis"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8427-9373","authenticated-orcid":false,"given":"Fr\u00e9d\u00e9ric","family":"Baroz","sequence":"first","affiliation":[{"name":"Division of Clinical and Translational Research, Department of Medicine, McGill University, Montreal,","place":["Canada"]},{"name":"Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Division of General Internal Medicine, Department of Medicine, Geneva University Hospital, Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita S","family":"Suri","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-8330","authenticated-orcid":false,"given":"Abhinav","family":"Sharma","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Tom","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Takano","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Metabolic Disorders and Complications Program, Research Institute of the McGill University Health Centre, Montreal,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M","family":"Brophy","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Division of Cardiology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Beaubien-Souligny","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, Montr\u00e9al,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A","family":"Mavrakanas","sequence":"additional","affiliation":[{"name":"Division of Clinical and Translational Research, Department of Medicine, McGill University, Montreal,","place":["Canada"]},{"name":"Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal,","place":["Canada"]},{"name":"Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026090101320046600_bib1","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1016\/j.kint.2020.01.046","article-title":"Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference","volume":"97","author":"Flythe","year":"2020","journal-title":"Kidney Int"},{"key":"2026090101320046600_bib2","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1161\/HYPERTENSIONAHA.121.18058","article-title":"Association of different definitions of intradialytic hypertension with long-term mortality in hemodialysis","volume":"79","author":"Singh","year":"2022","journal-title":"Hypertension"},{"key":"2026090101320046600_bib3","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.5301\/ijao.5000126","article-title":"The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up","volume":"35","author":"Van\u00a0Buren","year":"2012","journal-title":"Int J Artif Organs"},{"key":"2026090101320046600_bib4","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1038\/sj.ki.5002077","article-title":"Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients","volume":"71","author":"Inrig","year":"2007","journal-title":"Kidney Int"},{"key":"2026090101320046600_bib5","doi-asserted-by":"publisher","first-page":"e0304633","DOI":"10.1371\/journal.pone.0304633","article-title":"The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on hemodialysis: a systematic review and meta-analysis","volume":"19","author":"Adejumo","year":"2024","journal-title":"PLoS One"},{"key":"2026090101320046600_bib6","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1038\/ki.2013.237","article-title":"A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival","volume":"84","author":"Park","year":"2013","journal-title":"Kidney Int"},{"key":"2026090101320046600_bib7","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of mortality risk with various definitions of intradialytic hypotension","volume":"26","author":"Flythe","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"2026090101320046600_bib8","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1159\/000500877","article-title":"The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis","volume":"49","author":"Kuipers","year":"2019","journal-title":"Am J Nephrol"},{"key":"2026090101320046600_bib9","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.2215\/CJN.02680314","article-title":"Intradialytic hypotension and risk of cardiovascular disease","volume":"9","author":"Stef\u00e1nsson","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101320046600_bib10","doi-asserted-by":"publisher","first-page":"2511","DOI":"10.1681\/ASN.2016060704","article-title":"Relationship between hypotension and cerebral ischemia during hemodialysis","volume":"28","author":"MacEwen","year":"2017","journal-title":"J Appl Sci Nanotechnol"},{"key":"2026090101320046600_bib11","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1186\/s12882-019-1662-x","article-title":"Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis","volume":"20","author":"Matsuura","year":"2019","journal-title":"BMC Nephrol"},{"key":"2026090101320046600_bib12","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.2215\/CJN.13891217","article-title":"The relationship between intradialytic hypotension and hospitalized mesenteric ischemia: a case-control study","volume":"13","author":"Seong","year":"2018","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101320046600_bib13","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.ekir.2019.01.001","article-title":"Cumulative exposure to frequent intradialytic hypotension associates with new-onset dementia among elderly hemodialysis patients","volume":"4","author":"Assimon","year":"2019","journal-title":"Kidney Int Rep"},{"key":"2026090101320046600_bib14","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1046\/j.1523-1755.2002.00505.x","article-title":"Predictors of the rate of decline of residual renal function in incident dialysis patients","volume":"62","author":"Jansen","year":"2002","journal-title":"Kidney Int"},{"key":"2026090101320046600_bib15","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1053\/j.ajkd.2019.08.019","article-title":"Ultrafiltration rate, residual kidney function, and survival among patients treated with reduced-frequency hemodialysis","volume":"75","author":"Lee","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"2026090101320046600_bib16","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s12882-019-1366-2","article-title":"Association between quality of life and various aspects of intradialytic hypotension including patient-reported intradialytic symptom score","volume":"20","author":"Kuipers","year":"2019","journal-title":"BMC Nephrol"},{"key":"2026090101320046600_bib17","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1186\/s12882-023-03263-6","article-title":"Impact of frequent intradialytic hypotension on quality of life in patients undergoing hemodialysis","volume":"24","author":"Wang","year":"2023","journal-title":"BMC Nephrol"},{"key":"2026090101320046600_bib18","doi-asserted-by":"publisher","first-page":"1693","DOI":"10.1016\/S0140-6736(22)01805-0","article-title":"Personalized cooler dialysate for patients receiving maintenance hemodialysis (MyTEMP): a pragmatic, cluster-randomized trial","volume":"400","author":"Garg","year":"2022","journal-title":"Lancet"},{"key":"2026090101320046600_bib19","doi-asserted-by":"publisher","first-page":"385","DOI":"10.2215\/CJN.08240718","article-title":"Associations between hemodialysis facility practices to manage fluid volume and intradialytic hypotension and patient outcomes","volume":"14","author":"Dasgupta","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101320046600_bib20","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1159\/000494806","article-title":"The impact of midodrine on outcomes in patients with intradialytic hypotension","volume":"48","author":"Brunelli","year":"2018","journal-title":"Am J Nephrol"},{"key":"2026090101320046600_bib21","doi-asserted-by":"publisher","first-page":"104975","DOI":"10.1016\/j.ijmedinf.2022.104975","article-title":"A comparative study of the definitions of intradialytic hypotension correlated with increased mortality to identify universal predictors","volume":"173","author":"Ngankem","year":"2023","journal-title":"Int J Med Informatics"},{"key":"2026090101320046600_bib22","doi-asserted-by":"publisher","first-page":"e63","DOI":"10.1097\/CCM.0000000000004710","article-title":"Practitioner\u2019s guide to latent class analysis: methodological considerations and common pitfalls","volume":"49","author":"Sinha","year":"2021","journal-title":"Crit Care Med"},{"key":"2026090101320046600_bib23","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von\u00a0Elm","year":"2007","journal-title":"Lancet"},{"key":"2026090101320046600_bib24","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1002\/j.1538-7305.1948.tb01338.x","article-title":"A mathematical theory of communication","volume":"27","author":"Shannon","year":"1948","journal-title":"Bell Syst Tech J"},{"key":"2026090101320046600_bib25","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1080\/10705510701575396","article-title":"Deciding on the number of classes in latent class analysis and growth mixture modeling: a monte carlo simulation study","volume":"14","author":"Nylund","year":"2007","journal-title":"Struct Equ Modeling"},{"key":"2026090101320046600_bib26","doi-asserted-by":"publisher","first-page":"920","DOI":"10.3389\/fpsyg.2014.00920","article-title":"Is adding more indicators to a latent class analysis beneficial or detrimental? Results of a Monte-Carlo study","volume":"5","author":"Wurpts","year":"2014","journal-title":"Front Psychol"},{"key":"2026090101320046600_bib27","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1093\/biomet\/88.3.767","article-title":"Testing the number of components in a normal mixture","volume":"88","author":"Lo","year":"2023","journal-title":"Biometrika"},{"key":"2026090101320046600_bib28","doi-asserted-by":"publisher","DOI":"10.1201\/9781003277965","article-title":"Model-based clustering, classification, and density estimation using mclust in","author":"Scrucca","year":"2023"},{"key":"2026090101320046600_bib29","article-title":"Latent profile analysis in R: a tutorial and comparison to Mplus","author":"Wardenaar","year":"2021","journal-title":"PsyArXiv"},{"key":"2026090101320046600_bib30","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1111\/j.1530-0277.2000.tb02070.x","article-title":"Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes","volume":"24","author":"Muth\u00e9n","year":"2000","journal-title":"Alcohol Clin Exp Res"},{"key":"2026090101320046600_bib31","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1007\/BF01246098","article-title":"An entropy criterion for assessing the number of clusters in a mixture model","volume":"13","author":"Celeux","year":"1996","journal-title":"J Classif"},{"key":"2026090101320046600_bib32","doi-asserted-by":"publisher","first-page":"289","DOI":"10.32614\/RJ-2016-021","article-title":"mclust 5: clustering, classification and density estimation using Gaussian finite mixture models","volume":"8","author":"Scrucca","year":"2016","journal-title":"R J"},{"key":"2026090101320046600_bib33","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.1016\/j.kint.2021.01.018","article-title":"The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality","volume":"99","author":"Keane","year":"2021","journal-title":"Kidney Int"},{"key":"2026090101320046600_bib34","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1111\/j.1542-4758.2011.00560.x","article-title":"Associations of endothelial dysfunction and arterial stiffness with intradialytic hypotension and hypertension","volume":"15","author":"Dubin","year":"2011","journal-title":"Hemodial Int"},{"key":"2026090101320046600_bib35","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1111\/sdi.12837","article-title":"Systolic and diastolic hypertension among patients on hemodialysis: musings on volume overload, arterial stiffness, and erythropoietin","volume":"32","author":"Georgianos","year":"2019","journal-title":"Semin Dial"},{"key":"2026090101320046600_bib36","doi-asserted-by":"publisher","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-induced cardiac injury: determinants and associated outcomes","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101320046600_bib37","doi-asserted-by":"publisher","first-page":"18054","DOI":"10.1038\/s41598-023-45282-1","article-title":"Real-time dual prediction of intradialytic hypotension and hypertension using an explainable deep learning model","volume":"13","author":"Yun","year":"2023","journal-title":"Sci Rep"},{"key":"2026090101320046600_bib38","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1186\/s12882-025-04270-5","article-title":"An explainable machine learning model for early warning of hypertensive and hypotensive anomalies in maintenance hemodialysis patients","volume":"26","author":"Li","year":"2025","journal-title":"BMC Nephrol"},{"key":"2026090101320046600_bib39","doi-asserted-by":"publisher","first-page":"396","DOI":"10.2215\/CJN.09280620","article-title":"Deep learning model for real-time prediction of intradialytic hypotension","volume":"16","author":"Lee","year":"2021","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026090101320046600_bib40","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1053\/j.ajkd.2021.01.022","article-title":"Accuracy of peridialytic, intradialytic, and scheduled interdialytic recordings in detecting elevated ambulatory blood pressure in hemodialysis patients","volume":"78","author":"Sarafidis","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"2026090101320046600_bib41","doi-asserted-by":"publisher","first-page":"788","DOI":"10.1053\/j.ajkd.2009.07.004","article-title":"Peridialytic, intradialytic, and interdialytic blood pressure measurement in hemodialysis patients","volume":"54","author":"Sinha","year":"2009","journal-title":"Am J Kidney Dis"},{"key":"2026090101320046600_bib42","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12882-023-03162-w","article-title":"Intra-dialytic blood pressure variability is a greater predictor of cardiovascular events in hemodialysis patients","volume":"24","author":"Liu","year":"2023","journal-title":"BMC Nephrol"},{"key":"2026090101320046600_bib43","volume-title":"2023 USRDS Annual Data Report: Epidemiology of kidney disease in the United States","author":"United States Renal Data System","year":"2023"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfag247\/70480800\/sfag247.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/9\/sfag247\/70480800\/sfag247.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/9\/sfag247\/70480800\/sfag247.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:32:07Z","timestamp":1788240727000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfag247\/8751127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":43,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfag247","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,4]]},"article-number":"sfag247"}}