{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T05:03:35Z","timestamp":1784783015453,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T00:00:00Z","timestamp":1784764800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014234","name":"Korean Society of Nephrology","doi-asserted-by":"publisher","award":["KHU-20251291"],"award-info":[{"award-number":["KHU-20251291"]}],"id":[{"id":"10.13039\/501100014234","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003625","name":"Ministry of Health and Welfare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003625","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic kidney disease (CKD) with diabetes is a heterogeneous condition with multiple underlying causes. However, no classification system appropriately captures the diversity of patients with CKD and diabetes or provides prognostic insights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We included 11,925 patients with CKD and diabetes from the Multicenter Cohort of Diabetic Kidney Disease Study (MEET-DKD) between 2000\u20132023. K-means clustering was implemented using thirty-two variables to identify the subtypes of CKD with diabetes. The associations between subtypes and cardiovascular events, progression to end-stage kidney disease (ESKD), and mortality were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three distinct diabetic CKD subgroups were identified; cluster 1 (n=4,494 [37.7%]) included predominantly older patients with multiple comorbidities and the highest medication use (comorbidity-dominant subtype); cluster 2 (n = 2,240 [18.8%]) included patients with lower renal function, and a moderate burden of comorbidities and medications (advanced CKD subtype); and cluster 3 (n = 5,191 [43.5%]) comprised patients with a higher prevalence of obesity, fewer comorbidities, and comparatively favorable laboratory profiles (obesity-dominant subtype). Compared with the obesity-dominant subtype, the comorbidity-dominant subtype exhibited the highest mortality risk (hazard ratio, 1.48; 95% confidence interval, 1.37\u20131.59). For progression to ESKD, using the comorbidity-dominant subtype as the reference, the advanced CKD subtype showed the highest risk (hazard ratio, 1.46; 95% confidence interval, 1.31\u20131.64). Similarly, compared with the comorbidity-dominant subtype, the obesity-dominant subtype showed the greatest risk of cardiovascular events (hazard ratio, 1.47; 95% confidence interval, 1.32\u20131.64).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study identified three distinct subgroups of diabetic patients with CKD with differential risks for major outcomes. This highlights the heterogeneity of CKD in patients with diabetes, and suggest that identified subtypes may provide additional prognostic information for risk stratification. Further external validation is required before clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1866115","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:46Z","timestamp":1784781046000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clustering-derived clinical subtypes and outcomes of chronic kidney disease in patients with diabetes: a multicenter cohort study"],"prefix":"10.3389","volume":"17","author":[{"given":"Jeong-Yeun","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Kyung Hee University Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyunjee","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Department of Precision Medicine, Kyung Hee University School of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong Keon","family":"Yon","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Department of Precision Medicine, Kyung Hee University School of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung Pyo","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2013Nephrology, Seoul National University Boramae Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Youl","family":"Rhee","sequence":"additional","affiliation":[{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]},{"name":"Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soie","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2013Nephrology, Chung-Ang University Hospital","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seokwoo","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2013Nephrology, Seoul National University Bundang Hospital","place":["Seongnam, Gyeonggi-do, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yaerim","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine\u2013Nephrology, Keimyung University Dongsan Medical Center","place":["Daegu, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyeon Seok","family":"Hwang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, College of Medicine, Kyung Hee University, Kyung Hee University Medical Center","place":["Seoul, Republic of Korea"]},{"name":"Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine","place":["Seoul, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843","article-title":"Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition","volume":"157","author":"Saeedi","year":"2019","journal-title":"Diabetes Res Clin Pract"},{"key":"B2","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S0272-6386(99)70035-1","article-title":"End-stage renal failure in type 2 diabetes: A medical catastrophe of worldwide dimensions","volume":"34","author":"Ritz","year":"1999","journal-title":"Am J Kidney Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1016\/j.kisu.2017.10.003","article-title":"Diagnosis of diabetic kidney disease: state of the art and future perspective","volume":"8","author":"Persson","year":"2018","journal-title":"Kidney Int Suppl (2011)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.861","article-title":"Temporal trends in the prevalence of diabetic kidney disease in the United States","volume":"305","author":"de Boer","year":"2011","journal-title":"JAMA"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60595-4","article-title":"Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention","volume":"382","author":"Gansevoort","year":"2013","journal-title":"Lancet"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2014.296","article-title":"Chronic kidney disease and intensive glycemic control increase cardiovascular risk in patients with type 2 diabetes","volume":"87","author":"Papademetriou","year":"2015","journal-title":"Kidney Int"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.11491116","article-title":"Diabetic kidney disease: Challenges, progress, and possibilities","volume":"12","author":"Alicic","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.05.012","article-title":"Molecular mechanisms and therapeutic targets for diabetic kidney disease","volume":"102","author":"Tuttle","year":"2022","journal-title":"Kidney Int"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnz010","article-title":"The new biology of diabetic kidney disease-mechanisms and therapeutic implications","volume":"41","author":"Lytvyn","year":"2020","journal-title":"Endocr Rev"},{"key":"B10","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1186\/s12916-022-02539-2","article-title":"New strategies to improve clinical outcomes for diabetic kidney disease","volume":"20","author":"Forst","year":"2022","journal-title":"BMC Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1038\/ki.2014.128","article-title":"Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes","volume":"87","author":"Molitch","year":"2015","journal-title":"Kidney Int"},{"key":"B12","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1053\/j.ajkd.2021.11.011","article-title":"Nonalbuminuric diabetic kidney disease and risk of all-cause mortality and cardiovascular and kidney outcomes in type 2 diabetes: Findings from the Hong Kong Diabetes Biobank","volume":"80","author":"Jin","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1053\/j.ackd.2014.03.003","article-title":"Cardiovascular complications of diabetic kidney disease","volume":"21","author":"P\u00e1lsson","year":"2014","journal-title":"Adv Chronic Kidney Dis"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2023.10.018","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","year":"2024","journal-title":"Kidney Int"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104489","article-title":"Identifying subtypes of chronic kidney disease with machine learning: development, internal validation and prognostic validation using linked electronic health records in 350,067 individuals","volume":"89","author":"Dashtban","year":"2023","journal-title":"EBioMedicine"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1093\/ckj\/sfag004","article-title":"Transforming nephrology through artificial intelligence: a state-of-the-art roadmap for clinical integration","volume":"19","author":"Cheungpasitporn","year":"2026","journal-title":"Clin Kidney J"},{"key":"B17","doi-asserted-by":"publisher","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"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1111\/1753-0407.13601","article-title":"Fasting blood glucose level and risk of all-cause and cause-specific mortality in peritoneal dialysis patients","volume":"16","author":"Lim","year":"2024","journal-title":"J Diabetes"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2022.110016","article-title":"Glycated hemoglobin levels and risk of all-cause and cause-specific mortality in hemodialysis patients with diabetes","volume":"190","author":"Kim","year":"2022","journal-title":"Diabetes Res Clin Pract"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.14745","article-title":"Chronic kidney disease diagnosis and management: a review","volume":"322","author":"Chen","year":"2019","journal-title":"JAMA"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2014.01.416","article-title":"KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD","volume":"63","author":"Inker","year":"2014","journal-title":"Am J Kidney Dis"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfad214","article-title":"How obesity and metabolic syndrome affect cardiovascular events, progression to kidney failure and all-cause mortality in chronic kidney disease","volume":"39","author":"Kang","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.23.098","article-title":"Fasting blood glucose and the risk of all-cause mortality in patients with diabetes mellitus undergoing hemodialysis","volume":"43","author":"Yoon","year":"2024","journal-title":"Kidney Res Clin Pract"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2025.1656800","article-title":"Predictive value of the triglyceride-glucose index for adverse clinical outcomes in chronic kidney disease","volume":"16","author":"Lee","year":"2026","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"98","DOI":"10.4285\/ctr.24.0004","article-title":"Comparison of depression and suicide between dialysis and kidney transplant recipients in Korea: a nationwide population study","volume":"38","author":"ang","year":"2024","journal-title":"Clin Transplant Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-025-06594-1","article-title":"Diverse combination of factors associated with the development of diabetic kidney disease among data-driven diabetes subtypes: analysis of the J-DREAMS registry","volume":"69","author":"Watanabe-Shimoji","year":"2026","journal-title":"Diabetologia"},{"key":"B27","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.ins.2022.11.139","article-title":"K-means clustering algorithms: A comprehensive review, variants analysis, and advances in the era of big data","volume":"622","author":"Ikotun","year":"2023","journal-title":"Inf Sci"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ympev.2022.107608","article-title":"Evaluation of various distance computation methods for construction of haplotype-based phylogenies from large MLST datasets","volume":"177","author":"Jacobson","year":"2022","journal-title":"Mol Phylogenet Evol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"14683","DOI":"10.1038\/s41598-022-14395-4","article-title":"Principal component analyses (PCA)-based findings in population genetic studies are highly biased and must be reevaluated","volume":"12","author":"Elhaik","year":"2022","journal-title":"Sci Rep"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13649","article-title":"Association of metabolic syndrome and chronic kidney disease","volume":"25","author":"Scurt","year":"2024","journal-title":"Obes Rev"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.03000315","article-title":"Arterial stiffness and decline in kidney function","volume":"10","author":"Sedaghat","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.23876\/j.krcp.23.283","article-title":"Comparisons of clinical outcomes between hypertensive and normotensive living kidney donors: a prospective, multicenter nationwide cohort study","volume":"44","author":"Kim","year":"2025","journal-title":"Kidney Res Clin Pract"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078063","article-title":"Predicting the risks of kidney failure and death in adults with moderate to severe chronic kidney disease: multinational, longitudinal, population based, cohort study","volume":"385","author":"Liu","year":"2024","journal-title":"BMJ"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.9225","article-title":"Accounting for the competing risk of death to predict kidney failure in adults with stage 4 chronic kidney disease","volume":"4","author":"Al-Wahsh","year":"2021","journal-title":"JAMA Netw Open"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfw075","article-title":"Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: a systematic review and meta-analysis","volume":"32","author":"Ladhani","year":"2017","journal-title":"Nephrol Dial Transplant"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2020.08.016","article-title":"Strategies to treat obesity in patients with CKD","volume":"77","author":"Chintam","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020030239","article-title":"Subtyping CKD patients by consensus clustering: the Chronic Renal Insufficiency Cohort (CRIC) Study","volume":"32","author":"Zheng","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104489","article-title":"Identifying subtypes of chronic kidney disease with machine learning: development, internal validation and prognostic validation using linked electronic health records in 350,067 individuals","volume":"89","author":"Dashtban","year":"2023","journal-title":"EBioMedicine"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1866115\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:30:55Z","timestamp":1784781055000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1866115\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,23]]},"references-count":38,"alternative-id":["10.3389\/fendo.2026.1866115"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1866115","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,23]]},"article-number":"1866115"}}