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The DBNs demonstrated strong predictive performance, as measured by the area under the receiver operating characteristic curve (AUCROC) and average precision (AP), with the highest values observed in the final year (Year 6), ranging from 0.83\u20130.89 and 0.28\u20130.37, respectively. A comparison of existing gold-standard CKD-Prognosis Consortium risk equations in real-world clinical settings with missing data demonstrated that DBNs\u2019 performance remained unaffected, while risk equations performed close to random due to their inability to handle missing data. The temporal structure of the DBNs captured longitudinal features changes and their interactions, with the most important observations over time including the urine albumin-creatinine ratio (UACR), the urine protein-creatinine ratio, and hemoglobin A1c. Notably, comparing DBN performance across institutions revealed that training on larger datasets generalized better.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study offers valuable insights into the development of DBNs using real-world population data from EHRs. The DBNs successfully identified patients at-risk for \u226540% eGFR decline and, despite missing data, offer opportunities for timely intervention and risk mitigation to preserve kidney function.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12911-026-03570-6","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T16:45:28Z","timestamp":1779295528000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Dynamic Bayesian networks to predict loss of kidney function: a cross-institution use case in a large cohort with or at-risk of CKD"],"prefix":"10.1186","volume":"26","author":[{"given":"Panayiotis","family":"Petousis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O. 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World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA J. Am. Med. Assoc. 2013, 310, 2191\u20132194. https:\/\/doi.org\/10.1001\/jama.2013.281053). Informed consent was waived because the study consisted only of a secondary analysis of de-identified data, in accordance with 45 CFR \u00a746. The study was approved by PHS (Washington, Montana, Oregon, New Mexico, Alaska, and California; IRB #SPK2043) and UCLA Health (IRB #20-000056) institutional review boards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors have nothing to disclose. KRT is supported by NIH research grants R01MD014712, U2CDK114886, UL1TR002319, U54DK083912, U01DK100846, OT2HL161847, UM1AI109568, and OT2OD032581, as well as CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264. She has also received investigator-initiated grant support from Travere Therapeutics Inc., Bayer, Doris Duke Charitable Foundation, and Benaroya Research Institute. She reports consultancy fees from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Travere Therapeutics Inc, and Pfizer, as well as speaker fees from Novo Nordisk. Additionally, she reports being chair of data safety monitoring boards for the National Institute of Diabetes and Digestive and Kidney Disease, and George Clinical Institute, and member of the data safety monitoring board for AstraZeneca. She reports leadership roles as chair for the Diabetic Kidney Disease Collaborative for the American Society of Nephrology, chair for Kidney Week 2025 Program Committee, and a member of the American Heart Association\/American College of Cardiology Cardiovascular-Kidney-Metabolic Guideline Committee.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"264"}}