{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T16:25:18Z","timestamp":1788020718965,"version":"build-2784847793"},"reference-count":38,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T00:00:00Z","timestamp":1667433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"AstraZeneca"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Hyperkalemia is associated with increased risks of mortality and adverse clinical outcomes. The treatment of hyperkalemia often leads to the discontinuation or restriction of beneficial but potassium-increasing therapy such as renin-angiotensin-aldosterone inhibitors (RAASi) and high-potassium diet including fruits and vegetables. To date, limited evidence is available for personalized risk evaluation in this heterogeneous and multifactorial pathophysiological condition. We developed risk prediction models using extreme gradient boosting (XGB), multiple logistic regression (LR), and deep neural network. Models were derived from a retrospective cohort of hyperkalemic patients with either heart failure or chronic kidney disease stage \u22653a from a Japanese nationwide database (1 April 2008\u201330 September 2018). Studied outcomes included all-cause death, renal replacement therapy introduction (RRT), hospitalization for heart failure (HHF), and cardiovascular events within three years after hyperkalemic episodes. The best performing model was further validated using an external cohort. A total of 24,949 adult hyperkalemic patients were selected for model derivation and internal validation. A total of 1452 deaths (16.6%), 887 RRT (10.1%), 1,345 HHF (15.4%), and 621 cardiovascular events (7.1%) were observed. XGB outperformed other models. The area under receiver operator characteristic curves (AUROCs) of XGB vs. LR (95% CIs) for death, RRT, HHF, and cardiovascular events were 0.823 (0.805\u20130.841) vs. 0.809 (0.791\u20130.828), 0.957 (0.947\u20130.967) vs. 0.947 (0.936\u20130.959), 0.863 (0.846\u20130.880) vs. 0.838 (0.820\u20130.856), and 0.809 (0.784\u20130.834) vs. 0.798 (0.772\u20130.823), respectively. In the external dataset including 86,279 patients, AUROCs (95% CIs) for XGB were: death, 0.747 (0.742\u20130.753); RRT, 0.888 (0.882\u20130.894); HHF, 0.673 (0.666\u20130.679); and cardiovascular events, 0.585 (0.578\u20130.591). Kaplan\u2013Meier curves of the high-risk predicted group showed a statistically significant difference from that of the low-risk predicted groups for all outcomes (p &lt; 0.005; log-rank test). These findings suggest possible use of machine learning models for real-world risk assessment as a guide for observation and\/or treatment decision making that may potentially lead to improved outcomes in hyperkalemic patients while retaining the benefit of life-saving therapies.<\/jats:p>","DOI":"10.3390\/nu14214614","type":"journal-article","created":{"date-parts":[[2022,11,3]],"date-time":"2022-11-03T03:53:07Z","timestamp":1667447587000},"page":"4614","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Machine Learning Models Predicting Cardiovascular and Renal Outcomes and Mortality in Patients with Hyperkalemia"],"prefix":"10.3390","volume":"14","author":[{"given":"Eiichiro","family":"Kanda","sequence":"first","affiliation":[{"name":"Medical Science, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suguru","family":"Okami","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3779-2972","authenticated-orcid":false,"given":"Shun","family":"Kohsaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjyuku-ku, Tokyo 160-8582, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masafumi","family":"Okada","sequence":"additional","affiliation":[{"name":"IQVIA Solution Japan K.K., Keikyu dai-ichi Building, 4-10-18 Takanawa, Minato-ku, Tokyo 108-0074, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojun","family":"Ma","sequence":"additional","affiliation":[{"name":"IQVIA Solution Japan K.K., Keikyu dai-ichi Building, 4-10-18 Takanawa, Minato-ku, Tokyo 108-0074, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Kimura","sequence":"additional","affiliation":[{"name":"Real World Data Co., Ltd., 76 Nakanocho, Nakagyo-ku, Kyoto 604-0086, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Shirakawa","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshitaka","family":"Yajima","sequence":"additional","affiliation":[{"name":"Cardiovascular, Renal, and Metabolism, Medical Affairs, AstraZeneca K.K., Tower B Grand Front Osaka, 3-1 Ofukacho, Kita-ku, Osaka 530-0011, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1056\/NEJMra1313341","article-title":"An Integrated View of Potassium Homeostasis","volume":"373","author":"Gumz","year":"2015","journal-title":"N. 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