{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:34:48Z","timestamp":1790832888612,"version":"4.1.0"},"reference-count":35,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T00:00:00Z","timestamp":1716854400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Cardiorenal syndrome (CRS) is a disorder of the heart and kidneys, with one type of organ dysfunction affecting the other. The pathophysiology is complex, and its actual description has been questioned. We used clustering analysis to identify clinically relevant phenogroups among patients with CRS. Methods: Data for patients admitted from 1 January 2012 to 31 December 2012 were collected from the French national medico-administrative database. Patients with a diagnosis of heart failure and chronic kidney disease and at least 5 years of follow-up were included. Results: In total, 13,665 patients were included and four clusters were identified. Cluster 1 could be described as the vascular\u2013diabetes cluster. It comprised 1930 patients (14.1%), among which 60% had diabetes, 94% had coronary artery disease (CAD), and 80% had peripheral artery disease (PAD). Cluster 2 could be described as the vascular cluster. It comprised 2487 patients (18.2%), among which 33% had diabetes, 85% had CAD, and 78% had PAD. Cluster 3 could be described as the metabolic cluster. It comprised 2163 patients (15.8%), among which 87% had diabetes, 67% dyslipidemia, and 62% obesity. Cluster 4 comprised 7085 patients (51.8%) and could be described as the low-vascular cluster. The vascular cluster was the only one associated with a higher risk of cardiovascular death (HR: 1.48 [1.32\u20131.66]). The metabolic cluster was associated with a higher risk of kidney replacement therapy (HR: 1.33 [1.17\u20131.51]). Conclusions: Our study supports a new classification of CRS based on the vascular aspect of pathophysiology differentiating microvascular or macrovascular lesions. These results could have an impact on patients\u2019 medical treatment.<\/jats:p>","DOI":"10.3390\/jcm13113159","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T07:38:39Z","timestamp":1716881919000},"page":"3159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Unsupervised Cluster Analysis in Patients with Cardiorenal Syndromes: Identifying Vascular Aspects"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-9506","authenticated-orcid":false,"given":"Jean-Baptiste","family":"de Freminville","sequence":"first","affiliation":[{"name":"Service de Cardiologie-M\u00e9decine Vasculaire, H\u00f4pital Trousseau, Centre Hospitalier Regional Universitaire de Tours, 37044 Tours Cedex 9, France"},{"name":"Service de Medecine Vasculaire, Hopital Europeen Georges Pompidou, Assistance Publique H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, 75015 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Michel","family":"Halimi","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie-Immunologie Clinique, H\u00f4pital Bretonneau, Centre Hospitalier Regional Universitaire de Tours, 37000 Tours, France"},{"name":"Facult\u00e9 de Medecine, UMR Inserm University of Tours 1327 ISCHEMIA \u201cMembrane Signalling and Inflammation in Reperfusion Injuries\u201d, 37044 Tours, France"},{"name":"F-CRIN INI-CRCT, 10, Boulevard Tonnell\u00e9, 37032 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0376-7894","authenticated-orcid":false,"given":"Valentin","family":"Maisons","sequence":"additional","affiliation":[{"name":"N\u00e9phrologie-Immunologie Clinique, H\u00f4pital Bretonneau, Centre Hospitalier Regional Universitaire de Tours, 37000 Tours, France"},{"name":"INSERM U1246 SPHERE, Universities of Nantes and Tours, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4327-5568","authenticated-orcid":false,"given":"Guillaume","family":"Goudot","sequence":"additional","affiliation":[{"name":"Service de Medecine Vasculaire, Hopital Europeen Georges Pompidou, Assistance Publique H\u00f4pitaux de Paris, Universit\u00e9 Paris Cit\u00e9, 75015 Paris, France"},{"name":"INSERM U970 PARCC, Universit\u00e9 Paris Cit\u00e9, 75015 Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-1800","authenticated-orcid":false,"given":"Arnaud","family":"Bisson","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de Medecine, UMR Inserm University of Tours 1327 ISCHEMIA \u201cMembrane Signalling and Inflammation in Reperfusion Injuries\u201d, 37044 Tours, France"},{"name":"Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Facult\u00e9 de M\u00e9decine, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Angoulvant","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de Medecine, UMR Inserm University of Tours 1327 ISCHEMIA \u201cMembrane Signalling and Inflammation in Reperfusion Injuries\u201d, 37044 Tours, France"},{"name":"Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Facult\u00e9 de M\u00e9decine, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9267-1658","authenticated-orcid":false,"given":"Laurent","family":"Fauchier","sequence":"additional","affiliation":[{"name":"Facult\u00e9 de Medecine, UMR Inserm University of Tours 1327 ISCHEMIA \u201cMembrane Signalling and Inflammation in Reperfusion Injuries\u201d, 37044 Tours, France"},{"name":"Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Facult\u00e9 de M\u00e9decine, 37044 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.atherosclerosis.2008.08.016","article-title":"Clinical and Subclinical Cardiovascular Disease and Kidney Function Decline in the Elderly","volume":"204","author":"Shlipak","year":"2009","journal-title":"Atherosclerosis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/j.jacc.2008.07.051","article-title":"Cardiorenal Syndrome","volume":"52","author":"Ronco","year":"2008","journal-title":"J. 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