{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T01:19:01Z","timestamp":1775265541504,"version":"3.50.1"},"reference-count":67,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T00:00:00Z","timestamp":1670803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Our study aimed to cluster dual kidney transplant recipients using an unsupervised machine learning approach to characterize donors and recipients better and to compare the survival outcomes across these various clusters. Materials and Methods: We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 2821 dual kidney transplant recipients from 2010 to 2019 in the OPTN\/UNOS database. We determined the important characteristics of each assigned cluster and compared the post-transplant outcomes between clusters. Results: Two clinically distinct clusters were identified by consensus cluster analysis. Cluster 1 patients was characterized by younger patients (mean recipient age 49 \u00b1 13 years) who received dual kidney transplant from pediatric (mean donor age 3 \u00b1 8 years) non-expanded criteria deceased donor (100% non-ECD). In contrast, Cluster 2 patients were characterized by older patients (mean recipient age 63 \u00b1 9 years) who received dual kidney transplant from adult (mean donor age 59 \u00b1 11 years) donor with high kidney donor profile index (KDPI) score (59% had KDPI \u2265 85). Cluster 1 had higher patient survival (98.0% vs. 94.6% at 1 year, and 92.1% vs. 76.3% at 5 years), and lower acute rejection (4.2% vs. 6.1% within 1 year), when compared to cluster 2. Death-censored graft survival was comparable between two groups (93.5% vs. 94.9% at 1 year, and 89.2% vs. 84.8% at 5 years). Conclusions: In summary, DKT in the United States remains uncommon. Two clusters, based on specific recipient and donor characteristics, were identified through an unsupervised machine learning approach. Despite varying differences in donor and recipient age between the two clusters, death-censored graft survival was excellent and comparable. Broader utilization of DKT from high KDPI kidneys and pediatric en bloc kidneys should be encouraged to better address the ongoing organ shortage.<\/jats:p>","DOI":"10.3390\/medicina58121831","type":"journal-article","created":{"date-parts":[[2022,12,13]],"date-time":"2022-12-13T01:56:06Z","timestamp":1670896566000},"page":"1831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Phenotypes of Dual Kidney Transplant Recipients in the United States as Identified through Machine Learning Consensus Clustering"],"prefix":"10.3390","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-2338","authenticated-orcid":false,"given":"Supawit","family":"Tangpanithandee","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charat","family":"Thongprayoon","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-9519","authenticated-orcid":false,"given":"Caroline C.","family":"Jadlowiec","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7571-2542","authenticated-orcid":false,"given":"Shennen A.","family":"Mao","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1814-7003","authenticated-orcid":false,"given":"Michael A.","family":"Mao","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pradeep","family":"Vaitla","sequence":"additional","affiliation":[{"name":"Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Napat","family":"Leeaphorn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2920-7235","authenticated-orcid":false,"given":"Wisit","family":"Kaewput","sequence":"additional","affiliation":[{"name":"Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6010-0033","authenticated-orcid":false,"given":"Pattharawin","family":"Pattharanitima","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Thammasat University, Bangkok 12120, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2888-881X","authenticated-orcid":false,"given":"Pajaree","family":"Krisanapan","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Division of Nephrology, Department of Internal Medicine, Thammasat University, Bangkok 12120, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0245-2954","authenticated-orcid":false,"given":"Pitchaphon","family":"Nissaisorakarn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Cooper","sequence":"additional","affiliation":[{"name":"Medstar Georgetown Transplant Institute, Georgetown University School of Medicine, Washington, DC 21042, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9954-9711","authenticated-orcid":false,"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"77","DOI":"10.4103\/0971-4065.97101","article-title":"The global role of kidney transplantation","volume":"22","author":"Garcia","year":"2012","journal-title":"Indian J. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1111\/j.1600-6143.2011.03686.x","article-title":"Systematic Review: Kidney Transplantation Compared with Dialysis in Clinically Relevant Outcomes","volume":"11","author":"Tonelli","year":"2011","journal-title":"Am. J. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1007\/s40258-020-00614-4","article-title":"The Cost-Effectiveness of Kidney Replacement Therapy Modalities: A Systematic Review of Full Economic Evaluations","volume":"19","author":"Yang","year":"2020","journal-title":"Appl. Health Econ. Health Policy"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1111\/j.1600-6143.2009.03008.x","article-title":"Organ Donation and Utilization in the United States, 1999\u20132008","volume":"10","author":"Klein","year":"2010","journal-title":"Am. J. Transplant."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/j.1600-6143.2010.03021.x","article-title":"Trends in Organ Donation and Transplantation in the United States, 1999-2008","volume":"10","author":"Wolfe","year":"2010","journal-title":"Am. J. Transplant."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1681\/ASN.2013070784","article-title":"New National Allocation Policy for Deceased Donor Kidneys in the United States and Possible Effect on Patient Outcomes","volume":"25","author":"Israni","year":"2014","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e14566","DOI":"10.1111\/ctr.14566","article-title":"Dual kidney transplants from adult marginal donors: Review and perspective","volume":"36","author":"Stratta","year":"2021","journal-title":"Clin. Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/S0039-6060(96)80002-X","article-title":"Double adult renal allografts: A technique for expansion of the cadaveric kidney donor pool","volume":"120","author":"Johnson","year":"1996","journal-title":"Surgery"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1097\/00007890-199604270-00023","article-title":"The Use of Bilateral Adult Renal Allografts-A Method to Optimize Function from Donor Kidneys with Suboptimal Neph-ron Mass","volume":"61","author":"Johnson","year":"1996","journal-title":"Transplantation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1016\/j.transproceed.2021.03.030","article-title":"Overcoming Mismatch Concerns for Adult Recipients of Small Pediatric Deceased Donor Kidneys","volume":"53","author":"Das","year":"2021","journal-title":"Transplant. Proc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e14737","DOI":"10.1111\/ctr.14737","article-title":"Outcomes of dual kidney transplants from high KDPI kidneys are superior compared to single kidney high KDPI transplants at 1 year","volume":"36","author":"Das","year":"2022","journal-title":"Clin. Transplant."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2060","DOI":"10.1097\/00007890-200005270-00015","article-title":"Double Versus Single Renal Allografts from Aged Donors","volume":"69","author":"Morales","year":"2000","journal-title":"Transplantation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1097\/01.ASN.0000054494.85680.1C","article-title":"Dual Kidneys from Marginal Adult Donors as a Source for Cadaveric Renal Transplantation in the United States","volume":"14","author":"Bunnapradist","year":"2003","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1097\/TP.0b013e3181f8f2b8","article-title":"Dual-Kidney Transplants as an Alternative for Very Marginal Donors: Long-Term Follow-Up in 63 Patients","volume":"90","author":"Caumartin","year":"2010","journal-title":"Transplantation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2781","DOI":"10.1111\/j.1600-6143.2012.04153.x","article-title":"Long-Term Results of Biopsy-Guided Selection and Allocation of Kidneys from Older Donors in Older Recipients","volume":"12","author":"Riera","year":"2012","journal-title":"Am. J. Transplant."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/01.tp.0000296855.44445.af","article-title":"Outcomes of Dual Adult Kidney Transplants in the United States: An Analysis of the OPTN\/UNOS Database","volume":"85","author":"Gill","year":"2008","journal-title":"Transplantation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1237","DOI":"10.1016\/j.transproceed.2013.02.031","article-title":"Middle and Long-term Outcomes of Dual Kidney Transplant: A Multicenter Experience","volume":"45","author":"Impedovo","year":"2013","journal-title":"Transplant. Proc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1111\/tri.12135","article-title":"Optimizing utilization of kidneys from deceased donors over 60 years: Five-year outcomes after implementation of a combined clinical and histological allocation algorithm","volume":"26","author":"Sefora","year":"2013","journal-title":"Transpl. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1056\/NEJMoa052891","article-title":"Long-Term Outcome of Renal Transplantation from Older Donors","volume":"354","author":"Remuzzi","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1433","DOI":"10.1111\/ctr.12475","article-title":"A single-center experience with 200 dual kidney transplantations","volume":"28","author":"Rigotti","year":"2014","journal-title":"Clin. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/TP.0000000000001508","article-title":"Dual Kidney Transplantation","volume":"101","author":"Snanoudj","year":"2017","journal-title":"Transplantation"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1111\/ajt.12553","article-title":"Kidneys at Higher Risk of Discard: Expanding the Role of Dual Kidney Transplantation","volume":"14","author":"Tanriover","year":"2014","journal-title":"Am. J. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1097\/00007890-200107270-00016","article-title":"Risk factors for renal allograft survival from pediatric cadaver donors: An analysis of united network for organ sharing data1","volume":"72","author":"Bresnahan","year":"2001","journal-title":"Transplantation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1016\/j.transproceed.2015.03.003","article-title":"Dual Kidney Transplantation: A Single-Center Experience","volume":"47","author":"Aawsaj","year":"2015","journal-title":"Transplant. Proc."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1016\/j.transproceed.2005.01.085","article-title":"Kidney Transplantation from Donors Aged 65 Years or More as Single or Dual Grafts","volume":"37","author":"Boggi","year":"2005","journal-title":"Transplant. Proc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/4141756","article-title":"Renal Transplants from Older Deceased Donors: Use of Preimplantation Biopsy and Differential Allocation to Dual or Single Kidney Transplant according to Histological Score Has No Advantages over Allocation to Single Kidney Transplant by Simple Clinical Indication","volume":"2018","author":"Casati","year":"2018","journal-title":"J. Transplant."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/j.transproceed.2016.02.007","article-title":"Expanded Criteria Donor Kidney Transplantation: Comparative Outcome Evaluation Between Single Versus Double Kidney Transplantation at 8 Years: A Single Center Experience","volume":"48","author":"Colonnelli","year":"2016","journal-title":"Transplant. Proc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1097\/00007890-200009150-00014","article-title":"Cadaveric \u201ctwo-in-one\u201d kidney transplantation from marginal donors: Experience of 26 cases after 3 years","volume":"70","author":"Dietl","year":"2000","journal-title":"Transplantation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/j.1399-0012.2006.00583.x","article-title":"Calcineurin inhibitor-free immunosuppression in dual kidney transplantation from elderly donors","volume":"21","author":"Furian","year":"2007","journal-title":"Clin. Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"565","DOI":"10.12659\/AOT.898328","article-title":"Dual Kidney Allocation Score: A Novel Algorithm Utilizing Expanded Donor Criteria for the Allocation of Dual Kidneys in Adults","volume":"21","author":"Johnson","year":"2016","journal-title":"Ann. Transplant."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1111\/ajt.12383","article-title":"Outcomes of Adult Dual Kidney Transplants by KDRI in the United States","volume":"13","author":"Klair","year":"2013","journal-title":"Am. J. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lee, K.W., Park, J.B., Cha, S.R., Lee, S.H., Chung, Y.J., Yoo, H., Kim, K., and Kim, S.J. (2020). Dual kidney transplantation offers a safe and effective way to use kidneys from deceased donors older than 70 years. BMC Nephrol., 21.","DOI":"10.1186\/s12882-019-1664-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2931","DOI":"10.1111\/ajt.13349","article-title":"Successful Transplantation of Kidneys from Elderly Circulatory Death Donors by Using Microscopic and Macroscopic Characteristics to Guide Single or Dual Implantation","volume":"15","author":"Mallon","year":"2015","journal-title":"Am. J. Transplant."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3091","DOI":"10.1016\/S0041-1345(02)03624-2","article-title":"One or two marginal organs for kidney transplantation?","volume":"34","author":"Perico","year":"2002","journal-title":"Transplant. Proc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1681\/ASN.V10122591","article-title":"Early Experience with Dual Kidney Transplantation in Adults using Expanded Donor Criteria","volume":"10","author":"Remuzzi","year":"1999","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2000","DOI":"10.1097\/00007890-200005270-00002","article-title":"Renal transplantation: Single or dual for donors aging \u226560 years?","volume":"69","author":"Remuzzi","year":"2000","journal-title":"Transplantation"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3771","DOI":"10.1016\/S0041-1345(01)02595-7","article-title":"Short-term outcome of dual kidney transplantation at a single center","volume":"33","author":"Rigotti","year":"2001","journal-title":"Transplant. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"3159","DOI":"10.1111\/ajt.14459","article-title":"Long-term outcome of renal transplantation from octogenarian donors: A multicenter controlled study","volume":"17","author":"Ruggenenti","year":"2017","journal-title":"Am. J. Transplant."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2542","DOI":"10.1111\/j.1600-6143.2009.02797.x","article-title":"Donor-Estimated GFR as an Appropriate Criterion for Allocation of ECD Kidneys into Single or Dual Kidney Transplantation","volume":"9","author":"Snanoudj","year":"2009","journal-title":"Am. J. Transplant."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1111\/j.1432-2277.2004.00068.x","article-title":"Long-term follow-up of double kidney transplantation using a score for evaluation of marginal donors*","volume":"18","author":"Wolters","year":"2005","journal-title":"Transpl. Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.transproceed.2019.10.019","article-title":"Training and Validation of Deep Neural Networks for the Prediction of 90-Day Post-Liver Transplant Mortality Using UNOS Registry Data","volume":"52","author":"Ershoff","year":"2020","journal-title":"Transplant. Proc."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Mao, S.A., Jadlowiec, C.C., Mao, M.A., Leeaphorn, N., Kaewput, W., Vaitla, P., Pattharanitima, P., Tangpanithandee, S., and Krisanapan, P. (2022). Machine Learning Consensus Clustering of Morbidly Obese Kidney Transplant Recipients in the United States. J. Clin. Med., 11.","DOI":"10.3390\/jcm11123288"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e221286","DOI":"10.1001\/jamasurg.2022.1286","article-title":"Use of Machine Learning Consensus Clustering to Identify Distinct Subtypes of Black Kidney Transplant Recipients and Associated Outcomes","volume":"157","author":"Thongprayoon","year":"2022","journal-title":"JAMA Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1023\/A:1023949509487","article-title":"Consensus Clustering: A Resampling-Based Method for Class Discovery and Visualization of Gene Expression Microarray Data","volume":"52","author":"Monti","year":"2003","journal-title":"Mach. Learn."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1139\/gen-2020-0131","article-title":"Machine learning for precision medicine","volume":"64","author":"MacEachern","year":"2021","journal-title":"Genome"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1007\/s41666-018-0029-6","article-title":"Nearest Consensus Clustering Classification to Identify Subclasses and Predict Disease","volume":"2","author":"Alyousef","year":"2018","journal-title":"J. Health Inform. Res."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Jadlowiec, C.C., Kaewput, W., Vaitla, P., Mao, S.A., Mao, M.A., Leeaphorn, N., Qureshi, F., Pattharanitima, P., and Qureshi, F. (2022). Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering. J. Pers. Med., 12.","DOI":"10.3390\/jpm12060859"},{"key":"ref_48","first-page":"1","article-title":"mice: Multivariate imputation by chained equations in R","volume":"45","year":"2011","journal-title":"J. Stat. Softw."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1572","DOI":"10.1093\/bioinformatics\/btq170","article-title":"ConsensusClusterPlus: A class discovery tool with confidence assessments and item tracking","volume":"26","author":"Wilkerson","year":"2010","journal-title":"Bioinformatics"},{"key":"ref_50","unstructured":"Robinson, A. (2022, October 05). Allocation of Dual and En Bloc Kidneys Two Year Post-Implementation Monitoring Report; OPTN Kidney Transplantation Committee: 21 March 2022, Available online: https:\/\/optn.transplant.hrsa.gov\/media\/33faxsvb\/data_report_kidney_full_20220321_508_remediated.pdf."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1097\/TP.0b013e3182279107","article-title":"En Bloc Kidney Transplantation from Pediatric Donors: Comparable Outcomes with Living Donor Kidney Transplantation","volume":"92","author":"Sharma","year":"2011","journal-title":"Transplantation"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Jannat-Khah, D.P., Unterbrink, M., McNairy, M., Pierre, S., Fitzgerald, D.W., Pape, J., and Evans, A. (2018). Treating loss-tofollow-up as a missing data problem: A case study using a longitudinal cohort of HIV-infected patients in Haiti. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-6115-0"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.jclinepi.2009.08.028","article-title":"Unpredictable bias when using the missing indicator method or complete case analysis for missing confounder values: An empirical example","volume":"63","author":"Knol","year":"2010","journal-title":"J. Clin. Epidemiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2920","DOI":"10.1002\/sim.3944","article-title":"Bias and efficiency of multiple imputation compared with complete-case analysis for missing covariate values","volume":"29","author":"White","year":"2010","journal-title":"Stat. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: Issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat. Med."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.jsat.2008.09.011","article-title":"The impact of loss to follow up on hypothesis tests of the treatment effect for several statistical methods in substance abuse clinical trials","volume":"37","author":"Hedden","year":"2009","journal-title":"J. Subst. Abuse Treat."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1016\/j.jclinepi.2006.01.014","article-title":"A gentle introduction to imputation of missing values","volume":"59","author":"Donders","year":"2006","journal-title":"J. Clin. Epidemiol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"6207","DOI":"10.1038\/srep06207","article-title":"Critical limitations of consensus clustering in class discovery","volume":"4","author":"Michailidis","year":"2014","journal-title":"Sci. Rep."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Pattharanitima, P., Thongprayoon, C., Petnak, T., Srivali, N., Gembillo, G., Kaewput, W., Chesdachai, S., Vallabhajosyula, S., O\u2019Corragain, O.A., and Mao, M.A. (2021). Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units. J. Pers. Med., 11.","DOI":"10.3390\/jpm11111132"},{"key":"ref_60","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Dumancas, C.Y., Nissaisorakarn, V., Keddis, M.T., Kattah, A.G., Pattharanitima, P., Petnak, T., Vallabhajosyula, S., Garovic, V.D., and Mao, M.A. (2021). Machine Learning Consensus Clustering Approach for Hospitalized Patients with Phosphate Derangements. J. Clin. Med., 10.","DOI":"10.3390\/jcm10194441"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Hansrivijit, P., Mao, M.A., Vaitla, P.K., Kattah, A.G., Pattharanitima, P., Vallabhajosyula, S., Nissaisorakarn, V., Petnak, T., and Keddis, M.T. (2021). Machine Learning Consensus Clustering of Hospitalized Patients with Admission Hyponatremia. Diseases, 9.","DOI":"10.3390\/diseases9030054"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1093\/qjmed\/hcab194","article-title":"Distinct phenotypes of hospitalized patients with hyperkalemia by machine learning consensus clustering and associated mortality risks","volume":"115","author":"Thongprayoon","year":"2022","journal-title":"QJM Int. J. Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1093\/ckj\/sfab190","article-title":"Subtyping hospitalized patients with hypokalemia by machine learning consensus clustering and associated mortality risks","volume":"15","author":"Thongprayoon","year":"2022","journal-title":"Clin. Kidney J."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s40620-021-01163-2","article-title":"Hypernatremia subgroups among hospitalized patients by machine learning consensus clustering with different patient survival","volume":"35","author":"Thongprayoon","year":"2022","journal-title":"J. Nephrol."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Nissaisorakarn, V., Pattharanitima, P., Mao, M.A., Kattah, A.G., Keddis, M.T., Dumancas, C.Y., Vallabhajosyula, S., Petnak, T., and Erickson, S.B. (2021). Subtyping Hyperchloremia among Hospitalized Patients by Machine Learning Consensus Clustering. Medicina, 57.","DOI":"10.3390\/medicina57090903"},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Sy-Go, J.P.T., Nissaisorakarn, V., Dumancas, C.Y., Keddis, M.T., Kattah, A.G., Pattharanitima, P., Vallabhajosyula, S., Mao, M.A., and Qureshi, F. (2021). Machine Learning Consensus Clustering Approach for Hospitalized Patients with Dysmagnesemia. Diagnostics, 11.","DOI":"10.3390\/diagnostics11112119"},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Thongprayoon, C., Vaitla, P., Nissaisorakarn, V., Mao, M.A., Genovez, J.L.Z., Kattah, A.G., Pattharanitima, P., Vallabhajosyula, S., Keddis, M.T., and Qureshi, F. (2021). Clinically Distinct Subtypes of Acute Kidney Injury on Hospital Admission Identified by Machine Learning Consensus Clustering. Med. 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