title: A novel tool for visualizing chronic kidney disease associated polymorbidity: a 13-year cohort study in Taiwan.
abstract: OBJECTIVE
  The aim of this study is to analyze and visualize the polymorbidity associated with chronic kidney disease (CKD). The study shows diseases associated with CKD before and after CKD diagnosis in a time-evolutionary type visualization.
  
  
  METHODS
  Our sample data came from a population of one million individuals randomly selected from the Taiwan National Health Insurance Database, 1998 to 2011. From this group, those patients diagnosed with CKD were included in the analysis. We selected 11 of the most common diseases associated with CKD before its diagnosis and followed them until their death or up to 2011. We used a Sankey-style diagram, which quantifies and visualizes the transition between pre- and post-CKD states with various lines and widths. The line represents groups and the width of a line represents the number of patients transferred from one state to another.
  
  
  RESULTS
  The patients were grouped according to their states: that is, diagnoses, hemodialysis/transplantation procedures, and events such as death. A Sankey diagram with basic zooming and planning functions was developed that temporally and qualitatively depicts they had amid change of comorbidities occurred in pre- and post-CKD states.
  
  
  CONCLUSIONS
  This represents a novel visualization approach for temporal patterns of polymorbidities associated with any complex disease and its outcomes. The Sankey diagram is a promising method for visualizing complex diseases and exploring the effect of comorbidities on outcomes in a time-evolution style.
  
  
  CONCLUSIONS
  This type of visualization may help clinicians foresee possible outcomes of complex diseases by considering comorbidities that the patients have developed.
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
authors: Chih-Wei
authors: CW
authors: Huang
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
authors: Shabbir
authors: S
authors: Syed-Abdul
authors: School of Health Care Administration, Taipei Medical University, Taipei, Taiwan Faculty of Health Sciences, Macau University of Science and Technology, Macau.
authors: Wen-Shan
authors: WS
authors: Jian
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
authors: Usman
authors: U
authors: Iqbal
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
authors: Phung-Anh Alex
authors: PA
authors: Nguyen
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Institute of Biomedical Informatics, National Yang Ming University, Taipei, Taiwan.
authors: Peisan
authors: P
authors: Lee
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan.
authors: Shen-Hsien
authors: SH
authors: Lin
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Department of Nephrology, New Taipei City Hospital, New Taipei City Government, Taipei, Taiwan.
authors: Wen-Ding
authors: WD
authors: Hsu
authors: Division of Nephrology, Taipei Medical University Hospital, Taipei, Taiwan School of Medicine, Taipei Medical University, Taipei, Taiwan.
authors: Mai-Szu
authors: MS
authors: Wu
authors: Department of Computer Science, University of California-Davis, California, USA.
authors: Chun-Fu
authors: CF
authors: Wang
authors: Department of Computer Science, University of California-Davis, California, USA ma@cs.ucdavis.edu jack@tmu.edu.tw.
authors: Kwan-Liu
authors: KL
authors: Ma
authors: Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan Department of Dermatology, Wan-Fang Hospital, Taipei, Taiwan. ma@cs.ucdavis.edu jack@tmu.edu.tw.
authors: Yu-Chuan Jack
authors: YC
authors: Li
mesh_terms: D001296:Audiovisual Aids; D015331:Cohort Studies; D015897:Comorbidity; D003626:Data Display; D018450:Disease Progression; D006801:Humans; D010363:Pattern Recognition, Automated; D010865:Pilot Projects; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D013624:Taiwan; D013997:Time Factors; D014584:User-Computer Interface
keywords: CKD Sankey diagram; CKD polymorbidity visualization; comorbidity visualization; data visualization; visualize analytic